What is Patient Compliance in Healthcare?
Patient compliance in healthcare is generally considered to be the degree to which patients follow the instructions of their healthcare providers with regards to medical advice, prescribed treatments, and recommended lifestyle changes. However, when discussing patient compliance in healthcare, it is important to distinguish between compliance, adherence, and concordance.
To best understand what patient compliance in healthcare is, it is necessary to understand the distinction between “compliance” (how well a patient passively follows their healthcare provider’s instructions), “adherence” (how well a patient actively follows their healthcare provider’s instructions), and “concordance” (how much the patient is involved in the decision-making progress).
This distinction is important because patients that are more involved in the decision-making process are more likely to comply with the decisions made about their health. Conversely, patients that passively follow instructions without understanding why, are more likely to stop taking medications and abandon attempted lifestyle changes when life events happen that weaken their resolve.
For the reasons explained below, it is important healthcare providers help “compliant” patients become “adherent” and “concordant” patients. This can be achieved by mitigating the factors that influence patient non-compliance, by building meaningful relationships with patients and their support networks, and by implementing processes to support and improve patient compliance in healthcare.
Why is Patient Compliance Important in Healthcare?
Patient compliance – in the general meaning of the term – is important in healthcare because of the human and financial costs of non-compliance. In the US, it has been estimated that 125,000 preventable deaths, 40% of nursing home admissions, and 10% of older patient hospitalizations each year are attributable to non-compliance – costing the healthcare system approximately $290 billion.
With regards to individual healthcare units, the failure of patients to follow the instructions of providers can increase hospital readmission rates, decrease patient satisfaction scores, and limit the effectiveness of subsequent treatments. It also becomes harder to reverse the consequences of non-compliance if a patient’s health condition has deteriorated to a more chronic stage.
Patient non-compliance also has a negative impact on workforce morale. Studies show that increased workloads attributable to avoidable readmissions negatively impact workforce morale. This can lead to absenteeism and increased staff turnover – further increasing patient workloads for remaining staff, affecting the standard of care, and increasing the risk of poor patient outcomes and costs.
Factors that Influence Patient Non-Compliance
The factors that influence patient noncompliance vary depending on the nature of the condition a patient is being treated for and their socioeconomic status. Typically, patients who are receiving treatment for more debilitating conditions such as HIV, MS, and epilepsy tend to be more compliant than patients receiving treatment for asthma, COPD, and diabetes according to the World Health Organization.
With regards to their socioeconomic status, patient compliance in healthcare can be influenced by factors such as the cost of medication compared to other household priorities, patients’ level of education, and peer pressure. Other factors include the accessibility of healthcare, patients’ experiences of treatment (i.e., side effects), comorbidities, and the number of providers involved in their care.
In recent years, the Internet has also had an increasing impact on patient compliance in healthcare. While this can have both positive and negative implications, the volume of health misinformation on the Internet – particularly on social media – is estimated to have cost up to $300 million per day during the COVID-19 pandemic due to hospitalizations, long term illnesses, and avoidable deaths.
How Providers Can Support Patient Compliance in Healthcare
In 2005, researchers developed the “SIMPLE” compliance strategy to help patients follow the instructions of their healthcare providers. While not a “one-size-fits-all” solution to patient non-compliance, elements of the strategy can be adopted by providers depending on factors affecting each non-compliant patient:
Simplify the advice to bite-sized amounts the patient can absorb.
Impart knowledge through clear instructions and shared decision-making.
Modify patient beliefs where necessary by addressing concerns about specific medications.
Provide communication and develop trust through active listening and empathy.
Leave the bias by taking time to overcome cultural and language barriers.
Evaluate adherence by asking patients simply and directly if they are following their treatment plans.
More recently, the CDC published a selection of pharmacy-based strategies for supporting and enhancing patient compliance in healthcare. The strategies include medication therapy management and an appointment-based model. However, the most effective strategy for supporting and enhancing patient compliance in healthcare would appear to be the pharmacist collaborative practice agreement.
Under this strategy, healthcare providers make diagnoses, supervise patient care, and refer patients to pharmacists. Pharmacists then perform specific patient care functions, such as renewing prescriptions, adjusting medications, and ordering lab tests. Where practical, this strategy could be extended to include family members, friends of the patient, and others in the patient’s support network.
There can be issues with this strategy when healthcare providers and pharmacists are separate entities, or when a patient exercises their HIPAA right to restrict disclosures of Protected Health Information. For this reason, providers who wish to support and enhance patient compliance in healthcare are advised to seek professional compliance advice before attempting to establish a provider-pharmacist relationship.
