Is patient adherence responsible for health quality and safety?

A while back I did in a post where I asked the question, What can patients really expect from their physicians today? In that post, I wondered at the fact that many patients still have a high degree of trust in their physician in spite of the quality and safety problems attributed to physicians in the press.

For example:

  • On average, US adults receive only 50% of recommended care
  • Up to 30% of adults are walking around with undiagnosed hypertension and diabetes
  • 66% of people with hypertension do not have it under control
  • Up to 20% of discharged hospital patients will be readmitted with 30 days even though they are considered preventable

Physician responses to the post make a prima facie argument that patient non-adherence is to “blame” for these safety and quality issues.

Physician Comment #1

“It would help if these data were accompanied by information on how many had been advised of their problem but failed to follow up. I read a study recently that showed only 50% of insured patients follow their doctor’s advice to obtain colonoscopy.”

Physician Comment #2

“Up to 30% of adults are walking around with undiagnosed hypertension and diabetes. How many of these patients have been told but are in denial… I cannot begin to tally up the number of patients told they have DM and ‘forgot about it.'”

The truth is that the quality of physician-patient communication is significantly correlated with patient adherence.  According to a 2009 study in Medical Care, there is a “19% higher risk of non-adherence among patients whose physician communicates poorly than among patients whose physician communicates well.”

For example research shows that:

  • 50% of patients walk out of the physician’s office not knowing what they were told or are supposed to do
  • Physicians often over estimate the topics and duration of what they have talked about with their patients
  • Telling patients once that they have diabetes, need a colonoscopy, need to lose weight, etc… is usually not enough to get the patient’s attention or buy in
  • Patient’s filter what they hear from their doctor in a variety of ways that physicians usually know nothing about, i.e., the patient’s health beliefs, values, previous experience and illness explanatory models

Anecdotally, the tone of the physician comments to my post suggests that their attitude towards non-adherent patients isn’t what you would call respectful … or patient-centered.   Attitudes like this are easily detected by patients and are not very conducive to build patient trust and adherence.

What’s the Solution?

  • Over time, get to understand your patient’s health beliefs, previous experiences, illness explanation, etc. with a goal of understanding their apparent non-adherence.
  • Help patients understand how or where their thinking may be inaccurate using evidence they can understand.
  • Repeat important messages during the same visit as well as across future visits.

The time you spend doing the above will be compensated by the time you save once you and their patients are on the same page.

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

Submit a guest post and be heard.

View 6 Comments >

Most Popular

Get KevinMD's 5 most popular stories.