Today millions of Americans are dependent on the daily use of a prescribed treatment regimen. Whether prescription drugs, or daily-use medical equipment, these therapies are only beneficial when properly followed. The question remains, though: how to ensure patient adherence? Adherence, or compliance, is defined as the degree to which a patient follows medical advice (such as with lifestyle or behavioral management), and follows prescribed therapies (medications, or the use of ambulatory oxygen, for example) as directed.
Adherence varies with the type of treatment prescribed. For medications, adherence rates are about 50 per cent; the rate is much lower when patients are asked to make significant lifestyle and behavioral adjustments. For durable medical equipment, or DME, adherence rates vary. Studies show that for patients using constant positive airway pressure (CPAP), between 29 to 83 percent of patients do not meet compliance standards. Adherence to oxygen therapy is low, averaging between 55 and 40 per cent.
What factors into adherence?
There are many factors involved in patient adherence. Recent studies corroborate that effective communication greatly – and positively – affects patient satisfaction, health status, and recall of information and adherence. In analyzing 106 physician-patient communication studies, more than 98% of patients demonstrated a positive relationship between physician communication and patient adherence. Patients whose physician was a good communicator were 2.1 times more likely to adhere to their prescribed regimen.
What are the barriers to patient adherence?
Non-adherence can result for a number of reasons, though in an informal poll of diabetics, the top four deterrents were directly linked to inadequate information or training, and difficulties in integrating prescribed regimens into their everyday routine. Reported deterrents included:
- Time management: Depending on time constraints, patients may have to choose between treatment and other daily activities like sleeping, or exercising.
- Scheduling and maintenance: Long-term treatment requires not only a daily discipline, but also ensuring timely medications refills and, in the case of DME, equipment maintenance and upkeep.
- Comprehension: Medical professionals may not have time to adequately instruct patients in the specifics of their treatment regimen; additionally, patients and caregivers may take away only a portion of the instructions given, or may misunderstand them.
- Lack of Information: Generally, patients are unaware of treatment options available to them. They may also be confused about how medications are administered, and how to maintain durable medical equipment, when necessary.
How to bolster patient adherence:
Adherence is necessary for a patient’s health to improve. The medical industry has moved away from placing full responsibility with patients to understand and follow prescribed treatments, and more emphasis on improving physician communication styles. In a study of oxygen users, “[most] respondents described a single conversation with their doctors about oxygen that occurred at the time of their initial prescription.” Integrating prescribed treatments into a patient’s life can entirely alter their routine, making adequate training a must – not only at the initial prescribing appointment, but on an ongoing basis.
Other medical professionals can also be effective in conveying information to the patient. Nurses, pharmacists, technicians, and home health care providers may have more time to interact with the patient, and more information to disseminate due to familiarity with products or medications. In recent years, physicians have begun to trust DME companies, and value the DME provider’s input for appropriate equipment selection. Instructing patients in the use of durable medical equipment requires additional training, both for the patient and for the delivery technician. Because training is ongoing for their employees, DME companies can offer current reference materials, and industry-certified customer service support and technicians to address questions and concerns. DME providers may also follow up with patients to ensure adherence and proper use of equipment.
While current adherence rates are low, medical professionals and medical suppliers are working to increase the number of patients who not only follow their prescribed treatment, but understand it as well. Communication is the key to improving adherence – both in and out of the doctor’s office.