Significant proportions of people walk out of doctors’ clinics and disregard or fail to act on the opinion offered. The data reported in the literature does not make for encouraging reading. This behaviour has been observed in almost every clinical scenario and every speciality:
Medication compliance in pediatric patients ranges from 11% to 93%. At least one third of all patients fail to complete relatively short-term treatment regimens.
Of the 137 patients included in the study, 32% did not show up for their first appointment.
Similarly, although men receiving health education learned a lot about hypertension, they were not more likely to take their medicine.
We conclude that compliance with the once-daily regimen was best, but that compliance with a twice-daily regimen was very similar, and both were superior to dosing three times a day.
Seven hundred and two patients (14.5%) did not redeem 1072 (5.2%) prescriptions during the study period, amounting to 11.5% of men and 16.3% of women.
Eighty percent of 223 patients enrolled completed the study by returning their bottles. The rate of strict compliance with prescription instruction was 25%. The rate of noncompliance was 24%. Fifty-one percent used some intermediate amount of medication. There was no statistical difference in compliance by gender, presence or absence of symptoms, or site of enrollment.
Ultimately, this study suggests that health professionals need to understand reasons for non-compliance if they are to provide supportive care and trialists should include qualitative research within trials whenever levels of compliance may have an impact on the effectiveness of the intervention.
The fact that this happens is important because it is a costly waste of resources. There are many explanations for this phenomenon but they are all summarised in the findings of one study:
Studies have shown, however, that between one third and one half of all patients are non-compliant, but different authors cite different reasons for this high level of non-compliance. In this paper, the concept of compliance is questioned. It is shown to be largely irrelevant to patients who carry out a ‘cost-benefit’ analysis of each treatment, weighing up the cost/risks of each treatment against the benefits as they perceive them. Their perceptions and the personal and social circumstances within which they live are shown to be crucial to their decision-making. Thus an apparently irrational act of non-compliance (from the doctor’s point of view) may be a very rational action when seen from the patient’s point of view. The solution to the waste of resources inherent in non-compliance lies not in attempting to increase patient compliance per se, but in the development of more open, co-operative doctor-patient relationships. Donovan and Blake
What practitioners can do without waiting for policy change is to review their communication style. As Bungay Stanier has suggested it can’t be assumed that the first thing the person mentions is what is uppermost in their mind. Bungay Stanier’s suggested questions will reduce the rush to action. A rush that fails to identify the issue that the patient may feel is a greater priority than hypertension or diabetes.
Picture by Sergio Patino