Even under the best circumstances, there is often a great difference between what doctors say to patients and what patients actually hear and understand
Of course, understanding medical advice is only part of the issue. Even when people know exactly what their doctors want them to do, they may choose not to follow through, for a variety of reasons.
Some patients may not be convinced the therapy will help. Others may hold beliefs that discourage them from following a doctor’s advice
A patient’s decision to not comply with medical advice may be the result of careful consideration
Patients on chronic medications are often concerned about their dependence on a drug, for example, and may experiment with doses to feel in control. Especially when a regimen is complex or costly, patients often weigh the risks and benefits and then decide that following the therapeutic advice simply isn’t worth the trouble or cost.
And patients worried about side effects may elect to take less of the drug than prescribed in order to reduce the perceived risks
As John Steiner, MD, MPH, and Mark Earnest, MD, point out in the June 6, 2000, issue of Annals of Internal Medicine, “Patients make a fundamental distinction between unintentional variations in medication-taking due to forgetfulness or disruption of daily routines and intentional variations that occur when patients individualize medical advice as part of their adaptation to their illness.”
There is no simple solution to the stubborn problem of poor compliance, but there are a few steps you can take to encourage your patients to follow your recommendations. Most of these strategies require taking a little extra time with your patients,
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Convince your patients that the treatment plan is necessary and efficacious.
If patients don’t believe the treatment you propose is necessary and likely to work, they have little incentive to follow through.
Warning a patient about the potential dangers of not adhering to treatment is important
2. Explain exactly what your patients should expect.
A drug’s potential side effects.
Yet one of the main reasons people skip or stop taking medications, studies show, is because they are worried about unexpected side effects.
To improve compliance, experts say, be sure to cover five key issues when prescribing medication:
- What the drug does
- How it should be taken
- What the major side effects are
- What patients should do if they experience side effects
- How the drug’s effect will be monitored
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Listen carefully It’s often not easy to sit down and just listen. But taking a few minutes to hear your patients’ concerns and answer their questions can make a big difference in compliance
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Assess your patients’ mental state clinicians should be alert to signs of depression in patients who are having trouble complying with medical instructions
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Enlist the help of family or friends Patients who have strong social ties typically comply better than socially isolated individuals. you can help by asking a family member to attend the office visit when you intend to discuss treatment options.
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Keep medication regimens as simple as possible The simpler the regimen, the more likely a patient is to follow it.
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Troubleshoot potential obstacles. A complicated or demanding treatment plan is a challenge for even the most motivated patient. Ask patients if they foresee problems with following through. Have they had trouble taking medications in the past? Is there anything specific that interferes? Talk over ways to make compliance easier
8. Build reminders into the treatment plan The leading reason most patients fail to take their pills is simple: they forget. Helping patients to organize their schedules and build in reminders is vital, especially for those taking medications on a regular basis or many times a day.
One simple strategy is for patients to put a colored sticker, available at office-supply stores, on their calendar each time they take a pill. Electronic beepers, watches that vibrate when it’s time to take a pill, automatic dispensers, and pill boxes with programmable reminders are also available
9.Include a plan to monitor compliance. Explain to patients that everyone has trouble following through on medical recommendations. Emphasize how important following the treatment plan is, and then come up with a plan to monitor compliance. Ask patients to contact you if they encounter trouble or if they begin to have second thoughts about what you’ve prescribed
10. Ask your patients how they are doing. Always ask patients how they’re doing when it comes to taking medications or following other recommendations
For lifestyle changes, such as dietary alterations or increased physical activity, make it clear that most people have to work hard to change personal habits. Ask patients to talk about why they’re having trouble.
Helping patients follow medical advice as closely as possible depends on a close and trusting physician-patient relationship.
The graph below shows the leading reasons. It also suggests a blueprint for addressing the specific obstacles that patients report when asked to follow a complicated treatment regimen.
Reasons for missing doses of antiretroviral drugs
Compliance means taking the correct amount of the prescribed medicine at the proper time. Remembering to take your medicine is the key to compliance. Medicine will be effectively only when taken as prescribed.
“Drugs don’t work in patient’s who don’t take them” (Everett Koop)
“The real Drug Problem: Forgetting to take them” (Amy Dockser”)
Good patient compliance and adherence means taking the right drugs, on time and in the proper doses.