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Compliance and chronic disease
1Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205.
Insights
Patient compliance with medical regimens is crucial, especially for chronic diseases. Improving the doctor-patient relationship is key to enhancing adherence and treatment effectiveness.
Area of Science:
- Health Services Research
- Patient Adherence Studies
Background:
- Patient compliance with medical treatment regimens is increasingly important due to demographic shifts and advances in chronic disease management.
- Understanding compliance is essential for various conditions, including hypertension, and requires examining existing research for consistent findings.
- Non-compliance is more prevalent in chronic conditions, lifestyle-modifying treatments, and clinician-initiated appointments, with poor comprehension being a primary cause.
Purpose of the Study:
- To explore the multifaceted issue of patient compliance with medical treatment regimens.
- To identify factors influencing compliance and non-compliance in healthcare.
- To highlight the significance of the doctor-patient relationship in improving adherence.
Main Methods:
- Review of existing literature on patient compliance and non-compliance.
- Analysis of factors contributing to non-compliance, including patient characteristics, disease type, social support, and the therapeutic relationship.
- Examination of specific challenges faced by older patients in understanding and adhering to treatment plans.
Main Results:
- Non-compliance is higher in chronic conditions, lifestyle changes, and clinician-initiated visits.
- Lack of comprehension is the most frequent reason for non-compliance.
- Patient demographics, disease complexity, environmental support, and the doctor-patient relationship significantly impact compliance.
Conclusions:
- Non-compliance poses risks to treatment efficacy, leads to unnecessary procedures, and complicates outcome evaluations.
- Older patients are particularly vulnerable to non-compliance due to communication barriers and complex treatment regimens.
- Enhancing the doctor-patient relationship is a critical strategy for improving patient compliance and overall treatment success.
Abstract:
The shifting demographics of the population and increasing skill in treatment of chronic disease in this country have combined to make compliance a topic of greater salience than ever before. General issues of compliance are a necessary background to specific issues of compliance with regimens for single diseases such as hypertension. The definition of compliance continues to be modified, and examination of past work reveals certain consistencies in studies of compliance. Non-compliance is higher in chronic conditions, in activities requiring change in life-style, and in clinician-initiated visits. Noncomprehension of instructions is held to be the most frequent cause of noncompliance. Noncompliance is a threat to the course of treatment, increases unnecessary diagnostic procedures, and confounds evaluation of effectiveness. Factors related to compliance have been identified with regard to certain patient and disease characteristics, amount of support in the immediate environment, and the nature of the doctor-patient relationship. Older patients are often at greater risk in understanding regimens because clinicians educate this group less often, because symptoms are misunderstood by both patient and provider, and because of greater complexity in both conditions that are being treated and number of drugs and other aspects of treatment required. Methods of improving the doctor-patient relationship have been urged most recently as a means through which compliance can be increased.
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