On spite of the many well-conceived and well-executed post-prescription compliance programs, overall adherence rates have
remained unchanged, at 50 percent, for many years. Indeed, non-compliance rates are surprisingly high from one disease to
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).
While a multitude of psychosocial factors drive noncompliance, miscommunication is one of the major issues: The National Council
on Patient Information and Education reports that half of all patients forget verbal information communicated by their physicians,
while almost two-thirds (60 percent) are unable to report precisely what they were advised to do—even one hour after leaving
a doctor's office.
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.