On the issue of patient non-compliance, nobody said it better than former US Surgeon General C. Everett Koop while serving under President Reagan in the 80s: “Drugs don’t work on people who don’t take them.”
Since then, the problem of patients neglecting their doctors’ instructions has gotten a lot more serious.
At least 25% of today’s patients fail to comply with their doctor’s orders. For more complex conditions, the number surges to 70%. That’s a disconcerting trend, considering that almost 1/3 of Americans are wrestling with three or more complex chronic health conditions.
All this adds up to a major public health problem. It costs the US health system about $100 Billion every year, and causes untold numbers of needless readmissions and poor health outcomes. The issue of patient compliance, then, is crying out for intervention.
While there’s no silver bullet for patient non-compliance, there are tactics that physicians can use to nudge patients into better compliance with their care instructions.
Patient non-compliance costs the US health system about $100 billion every year, and causes many poor health outcomes.
But before exploring them, we should come to grips with non-compliance behavioral roots.
It’s a phenomenon that defies simple explanation. No two patients will have the same reasons for neglecting their doctors’ orders. Broadly speaking, though, their motivations for non-compliance will fall into one of two categories:
1. Unintentional non-compliance
These patients plan to follow their doctors’ instructions, but accidentally fall short.
The risk of this increases with case complexity. Difficult medicinal regimes can be hard to remember, and patients can simply forget them.
Sometimes, though, the problem stems from access issues — wait times at pharmacies, availability of clinics for follow-up, or even the prohibitively high price of certain drugs.
2. Intentional non-compliance
These patients are a different story. Patients who deliberately defy care instructions almost never do so lightly. In the case of medications, for example, intentionally non-compliant patients might fear the drugs’ side-effects, or else drug dependency, or stigma associated with the drug.
In the worst cases, patients who don’t comply take specific issue with their physicians. For whatever reason, their relationship with their doctor has soured, and they don’t trust that the doctor has their best interest at heart.
Situations like that make intentional non-compliance a thornier problem to solve. If a patient’s hostile to their doctor — or to medicine itself! — they’ll be unlikely to find a doctor persuasive.
Better, then, to focus on unintentional non-compliance. It will be easier to make headway and make a difference for patients.
One promising way to curb unintentional non-adherence has emerged very recently: mobile technology. Randomized controlled trials have shown that SMS reminders improve patient adherence to treatments for HIV, diabetes, and rheumatoid arthritis.
These are all conditions that come with extremely complicated care instructions. If mobile solutions work for them, they’ll likely work across a variety of ailments.
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But not just any solution will do. Physicians should carefully evaluate which platforms they deploy for their practices.
Considerations of design, functionality, and user-friendliness make some solutions better than others. The most successful, according to this meta-analysis, have the following features:
1. Expert input. Mobile health reminder systems suffer when there’s no clinical expertise behind them. Without clinicians lending a hand, a mobile solution can’t credibly claim to offer decision support, or even meaningful advice. Physicians should at least take a cursory look at the platform’s production team. If no one on board has an MD, it may be best to explore another option.
2. Specialization. Each medical specialty comes with unique demands. A gastroenterologist treating IBD patients, for example, will need entirely different ways to communicate with their patients, versus a psychiatrist specializing in post-traumatic stress. Any worthwhile solution will either be tailored to a specific specialty, or else be flexible enough to fit what that specialty requires.
3. Superior experience. Finally, physicians should get a first-hand feel for how potential mobile solutions perform. A platform with an intuitive interface, that seamlessly gives patients the information they want, can successfully encourage behavior change. But clunkier solutions will make them feel frustrated instead. Physicians may want to consider a trial run with a select group of patients, and get their feedback on how the solution feels for them.
Of course, none of these design factors can guarantee successful intervention. Doctors will still have to work at clear communication, at easing access to treatment, and at building trusting relationships with their patients.
But a mobile solution, if well-designed and judiciously employed, can be a handy tool have to in the clinical arsenal.