Healthcare is a collaborative process between physician and patient. A provider can make the best recommendations to address a patient’s particular needs, but it’s up to the patient to follow those instructions in their everyday life once they leave an appointment.
Patient compliance refers to the degree to which a patient follows their physician’s medical advice. It includes medication compliance, as well as medical device use, self-care, self-directed exercises, and cognitive assessments. How many patients follow that advice depends on many factors, including patient demographics, the physician-patient relationship, and the quality of education the physician provides.
According to research on medication adherence, an average of 45% of elderly patients are compliant with following medication recommendations from their physician. Only 50% of patients with chronic diseases such as diabetes and hypertension are compliant with their medication regimens, according to the World Health Organization (WHO).
Enhancing patient compliance improves individual health outcomes, and it can also improve the overall quality of healthcare. This article covers the obstacles to patient compliance and what healthcare providers can do to improve communication, education, and treatment follow-through.
Article Highlights
Patient compliance is the degree to which a patient follows their physician's medical advice, including medication, device use, self-care, exercises, and cognitive assessments. The term is often used interchangeably with adherence.
- Only about 50% of patients with chronic diseases such as diabetes and hypertension are compliant with their medication regimens, according to the World Health Organization.
- Direct healthcare costs associated with medication noncompliance are estimated at $100 to $300 billion annually.
- Four strategies can improve compliance: increase patient education, reduce barriers, simplify treatment regimens, and use consented reminders and one-on-one interactions.
What's the difference between patient adherence and patient compliance?
Patient adherence and compliance are often used interchangeably. In some cases, they have different connotations for active versus passive behavior, respectively.
For the purpose of this article, we use the terms synonymously, with compliance referring to the active choice patients make to follow through with their physician’s prescribed treatment while taking responsibility for their own well-being.
Patient compliance does not involve coercing patients to meet a specific standard or disregarding their concerns. Healthcare is a collaborative process, and healthcare providers have a significant role in helping patients overcome obstacles to compliance, such as lack of understanding or fear of medication side effects.
What is patient noncompliance?
Simply put, patient noncompliance means that a patient doesn’t follow a physician’s guidance. There are many reasons patient noncompliance might occur, including:
- Misunderstanding
- Miscommunication
- Capacity or resource limitations (e.g. prohibitive cost of medication)
- Individual constraints (e.g. memory problems)
- Inconsistency (e.g. patient stops treatment or medication after starting)
A World Health Organization report shows that noncompliance is directly associated with poorer treatment outcomes in various conditions such as diabetes, epilepsy, AIDS, asthma, hypertension, and organ transplants. When patients do not take their medications as prescribed, it can lead to increased hospitalizations and healthcare costs, according to health-system pharmacy research.
Patient noncompliance also poses a significant financial burden on the healthcare system. Published cost estimates place the direct healthcare costs associated with medication noncompliance between $100 and $300 billion annually.
What are the barriers to patient compliance?
Patients report the following barriers to compliance:
- Complex medication routines
- Poor health literacy
- Lack of understanding of treatment benefits
- Undiscussed side effects
- Poor treatment satisfaction
- Cost of prescription medication
A patient’s cognitive and emotional state can also affect compliance. According to research on chronic pain, cognitive and emotional factors influence the success of treatment for chronic pain, including how well patients stick to their medication protocols.
Addressing these factors may be the first step to enhancing patient compliance. By facing these challenges head-on, healthcare providers can help patients overcome barriers and move toward better health outcomes.
Why does patient compliance matter?
The significance of patient compliance lies in its direct impact on health outcomes. A comprehensive review of the literature identifies patient compliance as a critical factor associated with successful treatment outcomes. According to research on adherence outcomes, patient compliance may be crucial for reducing:
- Symptoms
- Disease complications
- Mortality rates
- Hospitalizations
- Emergency room visits
- Wasted medication
Enhanced compliance may lead to increased life expectancy, improved morbidity, empowerment, self-confidence, satisfaction, and better quality of life for patients with chronic illnesses. Conversely, noncompliance can lead to treatment failure, disease progression, and a decrease in patient quality of life.
The examples below cover cognitive assessment, non-pharmacological treatment, and medication, and how physicians can support patients in following their guidance.
Patient compliance examples by type of care
Cognitive assessment
Patient compliance is key when it comes to cognitive assessment. When patients reliably participate in these evaluations, healthcare providers can obtain detailed data on cognitive function, which is essential for diagnosing conditions like dementia or tracking the progression of neurodegenerative diseases.
Noncompliance can result in delayed diagnosis and treatment, negatively impacting the patient's health trajectory. In the context of computerized assessment, not completing testing may be one example of noncompliance. The reasons for such noncompliance may include misunderstanding instructions, experiencing difficulties with technology, or a distracting environment.
There are a number of ways to improve compliance in this scenario, including having a technician available for support, choosing a user-friendly platform, and having auditory instructions included in the platform.
Self-guided cognitive assessments available through Creyos can be administered in the comfort of patients’ homes, creating an engaging and enjoyable experience for patients which may improve compliance.
Non-pharmacological treatment
Patient compliance is also crucial in medical treatment plans that do not involve medication. Examples can include physical therapy for injury rehabilitation, dietary changes for weight management, or cognitive behavioral therapy for mental illness. Noncompliance with non-pharmacological treatment can prolong recovery, exacerbate symptoms, and increase the risk of complications.
Consider a patient who improvises their own workout instead of following a physiotherapist's knee rehabilitation regimen, potentially delaying recovery or worsening their condition. Or consider someone ignoring dietary advice after a cardiac event, risking further health complications.
These examples underscore the importance of compliance across all forms of treatment, not just those involving medications. It's essential for healthcare professionals to communicate the significance of these non-pharmacological treatments and to provide support and resources that encourage patients to adhere to their recommended care plans.
Medication and compliance
According to research on prescribed medication use, 50% of patients do not take their prescribed medications as directed, and most will stop the treatment as soon as they feel better.
Noncompliance can lead to ineffective treatment, the emergence of drug-resistant strains of infections, or even life-threatening situations in the case of conditions like hypertension or coronary heart disease. It’s also associated with increased healthcare costs due to hospital readmissions and additional treatments.
Read more: Pain Management Education for Patients: A Pain Care Provider Toolkit
How can clinicians improve patient compliance?
With the right strategies and a patient-centered approach, healthcare providers can significantly enhance patient compliance.
Clear communication is one of the most effective methods to enhance patient compliance. Patients need to understand:
- Their health condition
- The benefits of their prescribed treatment
- The consequences of noncompliance
- The steps involved in their care
This communication begins during the initial medical encounter with a primary care physician and continues through follow-up appointments and visits.
Four strategies to improve patient compliance
1. Increase patient education
Patient education is a crucial component of improving patient adherence. Providing patients with detailed, easy-to-understand information about their condition and treatment can increase their engagement and adherence to the treatment plan. Examples include written materials, educational videos, or interactive online resources. For pharmacological interventions, a better understanding of the medication, as well as their motivation and beliefs about the prescribed treatment can help mitigate poor compliance.
Patient education initiatives help patients understand their role in managing their health by sharing knowledge about disease processes, treatment options, and the potential consequences of noncompliance. According to a study on patient education, patient education promotes patient-centered care and increases adherence to medication and treatments.
2. Reduce barriers to compliance
Understanding and acknowledging the potential barriers that reduce patient compliance is essential to improving overall compliance. Research on treatment adherence indicates that patient nonadherence to treatment recommendations can be as high as 40% to 70%, particularly for complex regimens or lifestyle changes.
Beyond the barriers listed above, patient motivation, depression, denial, cognitive impairment, drug or alcohol use, and culture can also affect compliance.
Adherence rates for most medications to treat chronic conditions such as diabetes and hypertension usually fall in the 50% to 60% range, even among patients who have good insurance and drug benefits, according to research on chronic disease adherence.
3. Simplify treatment regimens
Simplifying treatment regimens can also improve compliance. Examples of best practices, when possible, may include healthcare providers opting for once-daily dosing, combination pills, or long-acting formulations to make it easier for patients to adhere to their prescribed medication regimen. Using pill counts and other tools that measure compliance can aid in this process.
Improved medication packaging, such as blister packs and dosage strips, have been shown to significantly improve patient compliance. One analysis of packaging interventions found that transitioning to simplified packaging resulted in a mean adherence rate of 71% compared with just 63% among control subjects. Additionally, packaging interventions using pill boxes and blister packs have been widely recommended to address the medication adherence issue.
4. Use reminders and one-on-one interactions
Reminders via text messages, emails, and calls can help patients remember their treatment regimens. Be sure to get patients to opt in and consent to receiving messages.
Establishing a supportive and cooperative healthcare environment can notably enhance patient compliance. By fostering a patient-physician relationship that respects the patient’s autonomy and encourages active involvement in their care, healthcare providers can increase patient satisfaction and improve adherence outcomes.
Lastly, using behavior modification strategies can help improve compliance. This could include:
- Setting realistic health goals
- Providing positive reinforcement for adherence
- Using reminder systems to help patients remember their medication doses and appointment times
Patient compliance with cognitive assessment tools
Cognitive assessment poses its own compliance challenges.
Many tools to monitor individual health require patient compliance, especially those that can be used outside the clinic. For example, cognitive assessments are an effective tool used to measure patient cognitive performance, and track the efficacy and impacts of treatments such as medication. For that reason, patient compliance plays an important role in the performance accuracy and usefulness of cognitive assessment. The reports generated from these assessments are also useful in improving patient compliance, such as by identifying where clearer education may be necessary.
There are a few notable blocks when assessing cognitive decline in patients. For example, many patients resist exploring memory concerns altogether, perhaps because of the nature of these concerns and because testing can be time-intensive and complex.
Technology can also be an intimidating factor and an accessibility barrier for older patients. Performing a cognitive assessment on a computer can create stress that affects their mindset. There are also limited tools available for evaluating cognitive impairment, identifying the specific areas of decline and measuring treatment efficacy for patients.
Several strategies have been identified to increase compliance when administering cognitive assessments. For example:
- Remote onboarding processes
- Videoconferencing to regularly observe patients
- Adjusting email subject lines and copy to increase relevance and create urgency
To learn more about increasing compliance with better patient communications, read about the email feature in Creyos: Five Ways to Increase Compliance When Administering Cognitive Assessments Via Email
With Creyos, medical providers can implement a robust battery of cognitive assessments on tablets, creating a comfortable environment for patients with the support of a technician. Up to 99% of patients complete cognitive assessments when adopting this method. This allows practitioners to measure early signs of mild cognitive impairment and communicate in detail to patients. The gamified user experience of Creyos tasks eases anxiety while capturing detailed information on the patient’s cognitive performance. Patients generally say they’re fun to complete.
Achieving better patient outcomes collaboratively
Patient compliance is vital for realizing the best health outcomes. Resolving noncompliance requires increasing patient education, reducing barriers to compliance, simplifying medication plans, and using consented reminders.
Patient compliance involves more than following a treatment plan. It also depends on:
- Understanding the importance of that plan
- Feeling empowered to participate in one’s care
- Having the resources and support necessary to adhere to the prescribed regimen
In this respect, health professionals play a crucial role in promoting and supporting patient compliance.
Understanding the challenges to patient compliance is a critical step toward improving it. By acknowledging and addressing these challenges, healthcare providers can help patients overcome these barriers and move towards better health outcomes.
With the right strategies and the right tools, like Creyos, healthcare providers can make patient compliance the norm.
Written by Mike Battista, Director of Science & Research at Creyos
Mike Battista specializes in brain health, cognition, and neuropsychological testing. He received his PhD in personality and measurement psychology at Western University in 2010 and has been doing fun and useful stuff in the intersection between science and technology ever since.