Not Following Treatment Recommendations Is Pervasive & Catastrophic

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Introduction

I have long had an abiding interest in what is most often been labeled “patient compliance.”1  The common definition, the degree to which a patient correctly follows medical advice, is misleadingly simplistic and itself the source of confusion. Today’s post focuses on the significance of medical compliance.

Prevalence Of Noncompliance

The only absolute criterion for patient noncompliance is that a clinician has made a treatment recommendation to a patient. Once that’s accomplished, it’s a numbers game; as the number of patients receiving the treatment recommendation increases, the likelihood noncompliance will occur approaches certainty, regardless of the treatment, disorder, patient demographics, astrological signs, … .

The prevalence of noncompliance varies, but the following examples are representative. The noncompliance rate for long-term medication is 50% to 60%. The rate of noncompliance for short-term therapy is 20% to 30%. Noncompliance with lifestyle changes is 70% to 80%.2

Significance

There is no impending pharmaceutical discovery, surgical innovation, or governmental policy change with greater potential for improving the health of patients and the efficacy of the healthcare system than simply increasing the percentage of treatment plans that patients carry out as prescribed.

Noncompliance with treatment is a healthcare catastrophe. Because many otherwise effective treatment plans are inadequately implemented or are not implemented at all,

  • Millions of unnecessary hospital admissions and thousands of preventable deaths (in the US alone) take place every year
  • Innumerable patients suffer needlessly prolonged, severe, or relapsed diseases
  • Healthcare dollars go to waste at an annual rate of $100 – $300 billion (in the US), losses in workplace productivity take an even higher toll, and patients, their families, and their communities endure profound financial, social, and psychological damage
  • Cascading misinformation, mistrust, and inefficiencies impair medical research, corrode the morale of clinicians, and imperil the healthcare system itself

Next: Medical Noncompliance Myths

All posts on this issue are collected at Medical Adherence

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  1. The debate over the appropriate name for this concept could itself support a book-sized treatise. Among frequently promoted alternative titles are adherence, capacitance, and concordance. []
  2. DiMatteo MR. Patient adherence to pharmacotherapy: the importance of effective communication. Formulary. 1995;30:596–8. 601–2, 605. []

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