In 2011, Consumer Reports published a survey of 660 primary care physicians, “What Doctors Wish Their Patients Knew.” The number-one complaint by far: Patients didn’t take the doctors’ advice or otherwise follow treatment recommendations.
Specifically, patients don’t follow through on their medication regimes: up to 75% of adults don’t take their medications as intended, a problem that is now among the most pressing in healthcare and described as “epidemic.” When you consider that in the U.S. some 3.8 billion prescriptions are written every year, that involves a lot of people.
The follow-through on antibiotics is interesting. Even though you have to take them for a very short time, 5 – 15 days, the compliance rate is still far from perfect. One study showed a compliance rate of 84% when you had to take 2 pills a day, but dropped markedly to 73% when you had to take 3 pills a day.
So what’s the problem?
Forgetfulness is the number-one barrier to compliance, experts believe, although a survey of 10,000 patients found that only 24% ascribed noncompliance to forgetfulness. Up to 20% failed to take medications because of perceived side effects, 17% had cost issues, and 14% didn’t feel the need to take medication; they believed it would have little or no effect on their disease.
But researchers caution that the reasons may be more troublesome, emanating from the murky depths of human psychology, and which the patients (not to mention medical researchers) may not fully understand.
So for example even when doctors are patients, they tend to act just like everyone else. So if you ask an audience of physicians for a show of hands of who has ever taken an antibiotic, many hands are raised. And if you then asks how many doctors took the full course of antibiotics even after their symptoms abated many hands go down.
This points to a deeper concern that says higher compliance rates may not even be possible. “We’re asking patients to adopt obsessive-compulsive behavior,” admits internist Edmund Pezalla, MD, MPH, National Medical Director of Pharmacy Policy & Strategy for the health insurer Aetna. “Taking medication every day is hard to do. We’re asking people to deal with the same boring situation over and over again. We’re not programmed to do that. Machines do that. Humans don’t do it very well.”
So what’s the answer?
With more than 40,000 peer-reviewed studies on the subject conducted over several decades, you’d think we’d at least be at Compliance 2.0 by now in the state of our knowledge. In reality, it’s more like Compliance 1.5. We are not on the verge of solving this immensely complex problem. The outlines of what is, at best, a partial solution are only just starting to emerge, say the authors of a special report on patient noncompliance.