Charlene Prounis

In spite of all the progress made in the last few years in reducing stigma and simplifying drug cocktails, many HIV patients with access to medication, for example, still die, with only 54 percent complying with prescribed therapy, according to data from Wilson Health Information, a pharmacy-research organization based in New Hope, Pennsylvania.

Medication non-compliance is also prevalent among other medical conditions, including depression (50 percent), chronic bronchitis (46 percent), and cancer (38 percent).

Even worse, only 35 percent of patients receive instructions from their physicians on how often to take medication. The critical moment during a scheduled visit when a doctor and physician interact—the doctor-patient encounter (DPE)—is vital. Often, this time is not leveraged properly, and instead of leaving the doctor's office well informed, the patient leaves without enough comprehensible information to comply with the prescribed treatment. As a result of this unintentional miscommunication, patients often feel misunderstood, dissatisfied, or even disrespected.

Igniting the therapeutic alliance early on can save money on efforts to bolster compliance and persistency in the future. Research supported by a Department of Health initiative investigating how patients can become partners in their medical treatment shows definitively that in order to fully benefit from their prescribed therapeutic regimens, patients must accept and understand their diagnoses, agree with the proposed treatment, and get their concerns addressed.

The goal of this kind of communication is to change patient behavior by building a compliance mindset during the encounter in the doctor's office. The encounter should involve an exchange of information that will ultimately lead to mutually satisfying decisions, develop a common understanding, and build trust. But, both doctors and patients must adhere to a set of responsibilities: Doctors are obliged to provide competent, patient-centered care with compassion and a willingness to engage with patients to achieve optimal long-term outcomes. Patients must be honest about their medical histories and other life circumstances, and take responsibility for raising their concerns during the DPE.

Given the obligations of each party and the anticipated improved outcomes, DPE programs should prepare patients to be partners in their own care. This can be accomplished by involving them in prescribing decisions and treatment options, encouraging them to take their medications, and teaching them the importance of refilling prescriptions and adhering to long-term treatment plans to achieve optimal outcomes.

This kind of enhanced communication is designed to overcome traditional roadblocks and ingrained behavioral patterns to prevent patients from opting out. They often include customized materials, such as targeted Q&As, patient instructions, or materials designed to enhance retention. Patients who leave physicians' offices with written information directly related to their needs and concerns can refer back after the visit to materials, which help them to understand their medical conditions and take necessary steps to treat them.