Managing Noncompliance By Aligning Patient and Clinician
To Create a Culture of Cooperation
Noncompliance: A Pandemic Problem
Noncompliance endangers the wellbeing and the lives of individual patients, ruinously wastes clinical resources, and dramatically increases healthcare costs. It also causes demoralization of healthcare professionals, conflicts between patients and clinicians, and risk to the community at large. Because efforts to control this problem have not been widely applicable or effective, the approach that follows is specifically designed to overcome the limitations of previous tactics.
Noncompliance Management
Were a physician to discover that, year after year, half of her patients fall prey to a malady that is rarely diagnosed correctly and that, in its worst form, results in death, that doctor would likely respond pragmatically. She would work from the hypothesis that every patient in her practice is acutely vulnerable to that affliction until demonstrated otherwise. She would then immunize or take other measures to protect all of her patients from the disease, whether or not those individuals show signs and symptoms of that disorder.
The high rate of medical noncompliance, our inability to reliably detect it when it does occur, and its potentially catastrophic outcomes all demand a similarly preemptive response. The first steps of a rational approach to combat this problem are (1) to acknowledge that every patient is at risk and (2) to implement practice-wide measures to prevent noncompliance to the extent possible and to detect and respond to noncompliance when it does occur. These measures break down as follows:
Creating a Culture Of Cooperation
- Aligning Patient and Clinician
- Involving Family & Community
- Synchronizing the Clinical Organization
Implementing Practical Solutions To Frequent Problems
- Eliminating Obstacles To Compliance
- Educating The Patient To Be A Patient
- Re-Educating Clinicians About Noncompliance Myths
- Communicating Instructions
- Recognizing Noncompliance
- Using Reminders For Patients & Clinicians
Focusing Effort in Special Cases
Some situations warrant special efforts. Priorities for such interventions are legitimately set by these criteria:
- Preventable morbidity, mortality, or disability is acutely likely if the treatment plan is not followed
- The disorder is chronic and carries significant long-term risk
- The direct cost of treatment is high or the treatment disproportionately consumes medical resources
- The patient cannot implement the treatment plan independently (because he or she is too young, cognitively impaired, physically incapacitated, etc.,) and his or her support systems are inadequate to assure that treatment is carried out.
Patients in the following categories typically meet one or more of these criteria:
- Organ Transplantation Patients
- Diabetes Patients
- HIV Patients
- Psychiatric Patients
- Patients With Lifestyle Disorders (Alcoholism, Substance Abuse, Smoking)
- Infants & Children
- Adolescents
- Elderly Patients
Implementing Special Interventions
While the foundation of the master strategy is the compliance enhancing elements that are highly integrated into the structure of the healthcare organization and can be routinely and automatically applied to the entire patient population, there are clinical circumstances that may be best managed by special interventions such as the following:
- Compliance Monitoring
- Incentive Programs
