{"id":1345,"date":"2017-11-22T22:37:17","date_gmt":"2017-11-23T06:37:17","guid":{"rendered":"https:\/\/www.seasidemedicalpractice.com\/dev\/\/dev\/?p=1345"},"modified":"2017-11-22T22:37:17","modified_gmt":"2017-11-23T06:37:17","slug":"patient-compliance-medical-management-conundrum","status":"publish","type":"post","link":"https:\/\/www.seasidemedicalpractice.com\/dev\/patient-compliance-medical-management-conundrum\/","title":{"rendered":"Patient Compliance- A Medical Management Conundrum"},"content":{"rendered":"

A 65 year old patient I began seeing few years ago started out in our first encounter proclaiming that she is as healthy as one can be.\u00a0 She exercises regularly, eats a balanced diet, has a positive outlook in life, and has never been told she has any medical conditions other than extensive precancerous and cancerous skin lesions for which she receives close dermatological care.\u00a0 In her youth, she was a sun bather and now, exactly the opposite, she stays away from the sun like it\u2019s the plague.\u00a0 Her weight is low-normal range, has excellent blood pressure readings, and always upbeat.\u00a0 When we ran the first battery of tests, we found her bone mineral density to be very low.\u00a0 This came as a shock to her.\u00a0 We discussed treatment options, including weight bearing exercises, vitamin D supplementation, bone resorption inhibitors, and hormone replacement therapy.\u00a0 She wanted to think about it further before committing to any \u2018aggressive\u2019 treatments.\u00a0 As years went by and her bone loss progressed, we continued to discuss management, and each time she would agree to some of the recommendations, but not all of them, then on follow up exams, she reported not following through on any of the recommendations.\u00a0 In our last encounter, 3 1\/2 years after our initial meeting, I asked her frankly, why are you not following through with medical advice, and her response was, \u201cI just feel so healthy, and I\u2019m doing all the right things\u201d.\u00a0 And there was the crux of the patient compliance issue.\u00a0 She was nonadherent\u00a0because she didn’t\u00a0connect\u00a0with the diagnosis. \u00a0 She didn\u2019t feel she has osteoporosis, therefore she couldn\u2019t bring herself to follow through with recommendations.<\/p>\n

Compliance with or adherence to a medication regimen means how likely is a patient to follow through on the recommendation of their physician, and the consensus is that 80 percent compliance is an acceptable benchmark.\u00a0 One of the most important determinants in patient outcome is the extent to which they comply. Reports of medication-related hospital admissions show that up to 69 percents at a cost of $100 billion a year are due to poor medication adherence.\u00a0 We can have the most accurate diagnostic testing, the best treatment modalities, and a solid physician-patient relationship, yet, if our patients don\u2019t actually put them to use, we will not see the desired outcomes.\u00a0 Compliance does not mean shake your head yes when you\u2019re in the doctor\u2019s office, take the prescription, and then as soon as you leave the front door, think \u201cWell, forget about that plan, I\u2019m not going to take this pill.\u201d<\/p>\n

Drugs don\u2019t work in patients who don\u2019t take them -C.E. Koop<\/strong><\/em><\/p>\n

Medication Nonadherence<\/h2>\n

Cost of medication, forgetfulness, lack of information and emotional factors are typical reasons cited by patients for not taking their medications.\u00a0 Ready access to internet has raised new issues with patient compliance as many patients justify and corroborate their doctor\u2019s advice on WebMD or some other online medical advice rendering site.<\/p>\n

\"stick<\/p>\n

Research shows medication compliance is higher among patients with acute conditions.\u00a0 However, persistence among patients with chronic conditions is disappointingly low, especially after the first 6 months, and with more frequent medication dosing.\u00a0 Good luck asking a patient to take a pill three times per day for the rest of their life.\u00a0 Even in clinical trials, where patients receive close attention, rate of adherence can be as low as 48 percent.<\/p>\n

\"take<\/p>\n

Here\u2019s an interesting breakdown of a study conducted in 2002 using a medication-monitoring device:<\/p>\n

1\/6 come close to perfect adherence to a regimen
\n1\/6 take nearly all doses, but with some timing irregularity
\n1\/6 miss an occasional single day’s dose and have some timing inconsistency
\n1\/6 take drug holidays three to four times a year, with occasional omissions of doses
\n1\/6 have a drug holiday monthly or more often, with frequent omissions of doses;
\n1\/6 take few or no doses while giving the impression of good adherence<\/p>\n

How Physicians Interact with Noncompliance<\/h2>\n

Turns out, physicians are terrible at recognizing noncompliance\u00a0and even worse at interventions trying to improve adherence.\u00a0 So what is the best way to give medical advice? How do we effectively relay news about a health condition, and convey confidence in our proposed treatment plans? What is the psychology of patients\u2019 complying with medical recommendations, especially when the psychological reasoning is further deteriorating their disease state? There is an actual psychiatric diagnosis associated with this condition, called psychological factors affecting other medical conditions (PFAOMC).<\/p>\n

Noncompliant Patient.\u00a0A\u00a0descriptor worth\u00a0ditching?<\/h2>\n

When you label a patient noncompliant, we automatically stigmatize their future relationship with their physicians.\u00a0 Before so doing, a physician should first address these important questions:<\/p>\n