SKILLS FOR SUCCESS

March/April 2007

Patient Perspectives on Medication Compliance

Donna R. Cryer, J.D.
CEO of CryerHealth, LLC

Costs to the pharmaceutical industry are escalating into the billions because of two salient factors: (1) patients do not take their medications as prescribed; and (2) physician reimbursement is shifting to a “pay-for-performance” model where doctors are judged by outcomes as well as interventions. As a result, interest in understanding why patients do and do not comply with their medications is increasing.

Physician surveys consistently report that a top complaint is that patients refuse to take their medications as directed. Just as consistently, patient surveys report that they are fully compliant with their medication regimens. Somewhere in between lies the truth.

Making Sense of the Terms
First, consider the term compliance. Compliance, as defined by the Random House Unabridged Dictionary, is the act of conforming, acquiescing, or yielding. The good news: Free will is no longer traded for blind obedience when clothes are traded for a paper gown. In this age of personalized medicine, patients demand—and deserve—a personalized plan that empowers them and inspires them to take their medication.

Second, consider how questions are asked. The physician says: “Have you taken your medicine?” This may seem like a yes or no question. But in fact, the patient is being asked a series of implied questions. “Did you fill the prescription in a timely manner? “ Did you take the right dose at the right time in the right way every time (with food, without food, with a full glass of water, on an empty stomach, without lying down for 30 minutes)?” “Did you take all the medicine (even after you felt better)?” “And did you refill the prescription as soon as you finished the first?” A patient may answer yes if she fulfilled even one of these criteria. There are any number of reasons that would drive a patient—even if diagnosed with diabetes, heart disease, or another serious, life-compromising condition—to not follow “doctor’s orders.”

  • Doesn’t like being ordered around by the doctor
  • Medication tastes bad
  • Side effects too much to bear
  • Method of administration painful or unpleasant
  • Taking the medication reminds the patient of her mortality
  • Doesn’t believe the condition is that serious
  • Treatment interferes with lifestyle
  • Forgot

Addressing the Challenges
So what can an army of pharmaceutical, medical, and communications professionals do when faced with a non-compliant patient?

1. Think of the patient as a person not a condition. A patient had a life before entering the doctor’s office and she will have a life afterward that includes, but may not be defined by, the particular condition that led her to seek care. As much as patient communications can honor and encompass a patient’s values, cultures, and life circumstances, the more successful these messages will be. There are numerous factors that need to be considered when developing a communications plan, such as:

  • Will the patient’s family need to be involved in the decision to begin or continue a therapy?
  • Does the method of administration embarrass the patient?
  • Is there an alternative medication that can be taken if, as prescribed (with food for example) it would violate a patient’s religious beliefs (during a period of fasting)?

2. Educate the patient to make her own decision. If patients fully comprehend the implications of the disease or condition—including the risks and benefits of various options for treatment and nontreatment—they can perform the personal calculus necessary to choose and value a treatment.

  • What is the timeframe for making a decision?
  • Are there consequences for waiting?
  • Would the medication avert surgery or other complications later?
  • Did the medical research include patients just like me?

3. Provide tools and approaches for success. Even a patient fully convinced and committed to a treatment plan can fail if she cannot overcome an obstacle course of barriers, such as cost, health literacy, and the vicissitudes of life.

  • Does the patient’s insurance cover the medication prescribed?
  • Can the patient afford the co-pay?
  • Does the patient have a ride to the pharmacy?
  • Is the complicated treatment regimen written in plain language? (“Once” is one time to an English speaker, 11 times to a Spanish speaker.)
  • Would a multi-compartment pill box or alarm watch help the patient remember?
  • Would a call from a member of the medical team a week after the visit make the patient feel both more supported and more accountable?

Communications, marketing, and other healthcare professionals who consider patients not as passive recipients of medications but as full partners in developing, describing, and delivering health solutions can achieve healthier companies and medical practices, as well as patients.