University of Iowa Health Science Relations and
Alan Christensen, PhD
Professor of Psychology/Internal Medicine
First Published: 2004
Last Revised: September 2004
Peer Review Status: Internally Peer Reviewed
If a doctor prescribes medication or recommends a specific treatment, but the patient never fills the prescription or ignores the recommendation, what's a doctor to do? Plenty, says Alan Christensen, PhD, a professor of psychology and internal medicine at the University of Iowa who studies patient "non-adherence" to medical regimens.
Christensen says most doctors know the statistics--fully half of their medical recommendations and/or prescriptions are not carried out. The economic impact is estimated at more than $100 billion per year in hospital costs, time off work, additional doctor visits and more expensive and potent drugs. The human toll in terms of increased disease, treatment complications and earlier death is even greater.
"It's a recognized problem, probably the biggest public health problem we face, but doctors are often unwilling to extend their perceived responsibility to when a patient leaves the office," Christensen says.
Christensen, a behavioral health expert and author of the new book, "Patient Adherence To Medical Treatment Regimens: Bridging the Gap Between Behavioral Science and Biomedicine," (Yale University Press, 2004), recommends a number of techniques doctors can use to increase patients' compliance with their instructions.
Giving patients a feeling of control over their own treatment by having them choose, for example, between a once- or twice-daily dose of medicine increases the likelihood that they will take it as prescribed, Christensen says. Another tactic is to schedule brief follow-up consultations by phone or in the office. Research shows that frequency of doctor-patient contact is more important than the duration of each contact for improving patient compliance.
"So three five-minute phone calls can be more effective in some cases than one 15-minute office visit," he says. "The point is to find some way that the patient feels involved in the decision. When you give someone a choice and they respond with a decision, that's a form of commitment to the process."
Patients also bear responsibility and should take a more active role in their own health care, Christensen says. They should understand that their lack of compliance has consequences not just for themselves but for society as a whole. For example, failure to complete a course of antibiotics contributes to the development of drug-resistant strains of bacteria. Christensen notes that the apparent overuse of unnecessary antibiotics, and its link to drug-resistant bugs, has received a great deal of attention in news reports and television shows, while very little has been made of the issue of failing to complete antibiotic treatment when it is necessary, a much more troubling problem in his view.
And parents who don't follow their own doctors' instructions are less likely to complete medical regimens prescribed for their children, which creates a vicious cycle as each new generation learns that doctors' orders can be adjusted or ignored. In one study described in Christensen's book, fewer than 20 percent of children taking penicillin by mouth for the treatment of potentially serious strep infections received the medication for the required 10-day treatment course, with many parents stopping their child's treatment after only a few days.
"It's not until we have tried and failed to adhere to a treatment plan that we realize it's not as easy as it sounds," Christensen says. "Health care providers need to recognize that difficulty and make sure patients know it's OK to ask for and receive help with their ability to follow through with medical directives. Doctors and patients together need to come up with treatment plans that suit their individual needs. There's no one-size-fits-all solution here."