Helping Patients Adhere To Medical Advise

Dear Dr. LeCrone:

I am a medical staff member in a large community health center. One of our biggest problems is having patients follow the recommended therapy. The issue of patient compliance is a major part of successful treatment. Will you please address this topic?

—A physician in New York

Dear Reader:

As you know, compliance occurs when the patient’s behavior coincides with directions from the health care provider.

Following medication prescriptions, a healthy diet, exercise program, smoking cessation and necessary psychological changes may be needed in treating such problems as hypertension, diabetes, heart disease, anxiety and depression.

Although the problem can be complex, there are a number of common reasons patients do not reach satisfactory compliance:

• The psychological makeup and beliefs of the patient.

• The nature of the patient’s problem and its treatment.

• The manner in which the patient and health care professional relate and interact.

• The patient should select a health care professional who is open, honest and can promote mutual trust and understanding. The patient must not deny problems or withhold information.

In some cases, problems can occur when the patient has impaired memory or the inability to comprehend and follow directions. Likewise, treating a patient who is overly suspicious or in poor contact with reality can be difficult and requires unique strategies.

Treatment expense and/or side effects of medications may also discourage adhering to treatment.

Noncompliance may occur if the patient is receiving secondary gain from being ill. Attention from family members or not having to return to work are examples of this.

Reasons for noncompliance are unique in each case, but these suggestions may help:

• Obtain a thorough examination by a health care professional to determine factors that may be contributing to a patient’s noncompliance.

• Insist on an honest and open discussion between the patient and health care professional.

• Seek support from the family or caregivers. Support persons should contribute any information that may lead to a better understanding of the patient, including cultural or religious factors.

• Use home health care services or other extended services if needed. Group support from hospitals or medical associations can provide resources.

• Obtain written information on following treatment plans and taking medications.

When needed, patient compliance can be achieved. Compliance can not only be beneficial but also be the difference between life and death.