Rethinking Patient Noncompliance – Again
Once more unto the breach, dear friends, once more1
Paul Tunnah, founder of pharmaphorum, an online pharma discussion and networking site, invited me to submit an overview of patient noncompliance. The first portion of that paper was published today at Rethinking patient noncompliance (Part 1).
While those who have followed my efforts on AlignMap will find little that is surprising, the article does, I think, offer a coherent, condensed summary of the current, problematic status of treatment adherence. The main points, sans discussion, follow:
The Dysfunctional Concept Of Patient Compliance
1. Patient compliance, as described by its standard definition, is a useful statistical measure but an inadequate and often counterproductive explanatory concept.
Key Point: The term patient noncompliance, by definition, is no more than a descriptive label given to a phenomenon and indicates nothing about the cause of that phenomenon.
2. Noncompliance leads to inadequate implementation of treatment recommendations, which itself leads to devastating economic and personal consequences.
Key Point: Characterizing the financial, physiological, and social costs of patient noncompliance as catastrophic is neither hyperbole nor hysteria, just fact.
3. Patient noncompliance is, by any measure and from any perspective, pervasive and difficult to detect.
Key Point: While patient compliance varies, a reasonable expectation, absent evidence to the contrary, is an average compliance rate of 50%.
4. No practical methodology has been shown to significantly, reliably, and enduringly enhances compliance for a diverse patient population.
Key Point: Many methodologies designed to enhance compliance are effective – for some patients some of the time; none of these methodologies are effective for most patients most of the time. Further, no methodologies have been demonstrated to predict which patients will and will not follow treatment recommendations or which patients will respond to which compliance enhancement techniques.
Solutions, AKA Coming Attractions
A new perspective on treatment adherence that offers potential solutions is the focus of Part 2 of Rethinking Patient Noncompliance, which will be published at pharmaphorum next week.
Part 1 of this piece is available now, in its entirety, at Rethinking patient noncompliance (Part 1).
__________- “King Henry V” by William Shakespeare: Act 3. Scene I↩