Photo Credit: Tero Vesalainen
Yvette C. Terrie, RPh, shares insights into addressing non-adherence and motivating patients to adhere to medication recommendations and health practices.
At some point in their careers, healthcare professionals may encounter patients who refuse to initiate or adhere to recommended treatment plans yet still expect their health issues to improve. Some patients may also disagree with the clinician’s expertise and continue with unhealthy habits, such as poor nutritional plans and sedentary lifestyles. Some patients attempt to adhere to clinician advice, but certain factors may affect their ability to comply with treatments.
Non-adherence can be classified as intentional or unintentional, affecting clinical outcomes to varying degrees. Identifying and addressing issues such as costs, fear of adverse drug reactions (ADRs), lack of understanding about medication and how to take it, negative attitudes toward medications, and limited access to healthcare that may adversely affect patient compliance is critical to improving compliance and clinical outcomes. According to a GoodRx Research Team survey, an estimated 30% of Americans do not fill prescriptions due to costs, and the American Medical Association (AMA) notes that patients do not take medications as prescribed an estimated 50% of the time and cited many of the reasons mentioned above .1,2
An abundance of literature has established that patients actively involved in their healthcare are more inclined to have improved outcomes and effective professional/patient communication. Establishing a good professional/patient relationship is integral to quality healthcare. For example, a rapid review published in BMC Health Services Research noted that effective communication between healthcare professionals and older patients positively impacts patient-centered outcomes, such as patient satisfaction, quality of care, quality of life, and physical and mental health.3 Findings from a systematic review and meta-analysis of randomized controlled studies published in PloS ONE revealed that the patient-clinician relationship has a small but statistically noteworthy influence on healthcare outcomes, highlighting the importance of patient-clinician teamwork in enhancing clinical outcomes.4
Sometimes, patients may forget to ask questions or be apprehensive about doing so during office visits. Findings from a 2021 survey revealed that many Americans experience challenges understanding or remembering medical information discussed during office visits with a lack of comprehension and forgetting the information soon after their visit, reported as 24% and 31%, respectively. Additionally, after an office visit, an estimated 15% reported feeling more confused about their health, 24% were unaware of how to access their health information, and 52% rarely reviewed their medical records. Results also revealed that three out of every four patients reported leaving an office visit “confused and dissatisfied for reasons that include disappointment in the level of Q&A they have with their doctor, confusion about their health, and a need to do more research.” 5 The survey also revealed that 59% of Americans contact their doctor directly post-appointment, while 80% research the doctor’s recommendations online.5
Clinician Perspectives
A pharmacist stated, “In my practice, I encounter patients who are non-compliant with their medications for various reasons. Some patients never fill or pick up new prescriptions due to the costs. Some don’t’ adhere due to the complexity of drug regimens, especially when they must take multiple medications several times a day. Others stop taking medications without consulting their PCP because they feel better, believe they no longer need the medication, or dislike the adverse effects. I encourage patients to discuss these issues with their PCP and never to stop taking medications without consulting them. I find that once-a-day formulations, when available, and simplifying drug regimens when feasible, can improve patient adherence.”
An internist stated, “Occasionally, I encounter a patient who does not want to adhere to a recommended treatment plan and continues to have health issues but does not understand why their health is not improving. In addition to medication when warranted, I try to help my patients understand that routine healthcare and lifestyle habits such as diet, exercise, tobacco cessation, and other measures are just as important as medication in improving their health and managing many diseases such as diabetes and CVD. I encourage patients to ask questions during a visit and remind them to contact my office if other questions or concerns arise afterward. As a clinician, I work with patients to improve their health and remind them to actively participate in their healthcare. It is rewarding to see patients improve, and I strive to continue encouraging those who struggle with non-adherence by understanding the causes and using effective strategies to address these issues when feasible.”
Conclusion
The clinician-patient relationship can have a profound effect on health outcomes. By improving communication and fostering confidence in the delivery of healthcare, clinicians can use shared decision-making measures that have the potential to motivate patients to be actively involved in improving their health by asking questions, encouraging them to follow the recommended treatment plans, setting realistic patient-centered goals, and informing patients about the numerous patient resources available to them including education and support programs as well as cost savings programs.
