Non-adherence is a major reason why treatments shown to be efficacious in trials are often less effective in clinical practice. Yet studies show that clinicians are poor at detecting non-adherence and therefore unable to address the underlying issues.
The consequences of non-compliance can be serious, and range from reducing the potential benefit of treatment to leading to a potentially dangerous escalation of medicines.
A recent report stated that in developed countries approximately 50 per cent of patients living with chronic disease do not adhere to treatment recommendations. A similar proportion do not take preventive medicines as prescribed. Some patients do not start their prescribed drugs, and of those who do, many subsequently discontinue.
Reasons for intentional non-adherence included the patient’s attitudes to medicines in general, their specific beliefs and their concerns and experiences about the treatment and the disease being treated. Opinions of friends and family were also highly influential. Reasons for unintentional non-adherence included misunderstanding or forgetfulness as well as factors beyond the patient’s control including the cost, complexity of administering the treatment and cognitive impairment.
Effective strategies to address non-compliance included a collaborative style, using the patient’s own expressions in responding to their utterances and cues, normalising non-adherence, and starting with open questions then following up with more specific probes
According to one study, of 1,169 patients treated for hypertension, doctors recognised non-adherence in fewer than half of those whose pharmacy records indicated significant gaps in dispensing. Prescribers were likely to escalate treatment even when significant noncompliance was suspected.
Effective strategies to address non-compliance included a collaborative style, using the patient’s own expressions in responding to their utterances and cues, normalising non-adherence, and starting with open questions then following up with more specific probes. In one study, questions that asked directly about missed doses were almost four times more likely to elicit disclosure of non-adherence than other question types. Disclosure can be followed up with a more detailed enquiry and discussion of ways to promote adherence and overcome barriers.”
The full report was published in Australian Prescriber.