Patient beliefs and their role in non-adherence

Patient non-adherence is a big problem. Non-adherence among chronic disease patients is associated with higher rates of hospital re-admissions, higher costs and poorer outcomes.

Research has identified over 200 possible factors thought to influence patient adherence. According to the experts, these factors can be categorized into two groups:

1. unintentional non-adherence
2. intentional non-adherence.

Unintentional non-adherence is related to a patient’s ability and resources to take their medication (e.g., problems with manual dexterity, forgetfulness, inability to pay for medication, etc.). Intentional non-adherence is associated with a patient’s motivation and beliefs, e.g., the reasons for needing a medication, the efficacy of a proposed treatment, concerns about side effects and so on.

Patient-centered communication and diabetes – An example
One of the basic tenets of the patient-centered care model is getting to know the “person behind the patient label, i.e., their health motivations, attitudes, beliefs and so on. Why? It is because people that show up in the doctor’s office each have their own pre-existing set of experiences, knowledge and beliefs about their health and the health care system.

A patient’s motivations, attitudes and beliefs are shaped by a variety of experiences. Maybe they had a family member or friend with the same health condition. Maybe they saw or heard a TV or radio commercial. Or maybe they had a previous bad experience with another provider. Regardless of where this thinking come from, or whether it is “right or wrong,” patient thinking plays an important yet often overlooked role in patient adherence.

Take the following “beliefs” expressed by a type 2 diabetes patient on a diabetes social networking site:

I keep reading where (having) type 2 diabetes is virtually a certainty for heart disease and an early death. These may be the statistics but l just haven‘t witnessed this in my personal life. My grandfather, a type 2 from his mid-40s lived to be 86. My father and two of his brothers were/are type 2 and my father lived to 83, his brother to 82, and one living brother just turned 80. These guys have out lived/are outliving most of their friends who are not diabetic.

To my way of thinking, if you read and put a lot of faith in articles like this you might as well throw your arms up and say “I give up…I’m doomed and nothing can save me.”

If you were this person’s physician, would you find it helpful if you knew this was how your patient thought? How adherent would you expect someone like this to be if you prescribed medication to lower their risk of heart disease (BP or cholesterol)?

Approximately 50% of diabetes patients are non-adherent when it comes to taking diabetes-related medications. Up to 70% of non-adherence is thought to be intentional according to researchers.

For whatever reason, lack of time, competing priorities, or perceived lack of importance, physicians don’t often ask patients about their health beliefs concerning their condition, treatment efficacy, or concerns about side effects. Probably even fewer patients volunteer such information. Such information is simply not relevant to the bio-medical, physician-centered model of care.

It certainly makes you wonder …

1. to what degree patient outcomes could be improved?
2. how much money could be saved?

… if physician better understood what makes their patients “tick?”

Steve Wilkins is a former hospital executive and consumer health behavior researcher who blogs at Mind The Gap.

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  • http://blogs.Strat-Cons.com Xavier Tello, MD

    Very well addressed problem.

    Patient compliance is a complex problem indeed and patient education should play a key role that potentially could avoid plenty of complications.

    A multifactorial approach should be evaluated for both physicians and healthcare related companies in order to warranty the best possible outcome for patients

    A year ago, we wrote this article regarding the “costly task” that an integral adherence program could represent: http://blogs.strat-cons.com/?p=1475

    Kind regards.

  • J

    Perhaps we need to evaluate when physician’s orders are actually necessary. When are we going to get beyond the current thinking of guidelines/ defensive medicine? As a physician’s child, I only wish for the best for the practice of medicine….

  • Anonymous

    With respect to the diabetes example, what about (for type 2) compliance with recommendations to increase exercise, lose body fat, and clean up one’s diet to help better control blood sugar and other risk factors?

  • http://queenslandhospitaldoctors.com.au Queensland Hospital Doctors

    I agree with you, non-adherence is a big problem not only in Chronic diseases, but non-observance in other diseases like asthma, hepatitis… may also cause re-admissions and wastage of money too.

  • http://somebodyhealme.dianalee.net Diana Lee

    Coming from the patient perspective, I always advice people to be honest about their concerns with their care providers. Open communication is the only way to work out a solution.