Exploration of Patient Adherence to Physician Recommendations in Laryngology Clinics

Effective patient adherence to physician-recommended care plans is critical for optimal health outcomes. Poor adherence can delay diagnosis, prolong symptoms, and worsen disease progression. Limited data exist on rates of patient adherence in laryngology and the barriers contributing to these gaps. This study aimed to quantify task completion rates following laryngology visits and identify factors associated with incomplete task completion.

A mixed methods quality improvement initiative was conducted on consecutive adult patients evaluated at the UCSF Voice and Swallowing Center. Retrospective review identified physician recommended care plans, including follow-up visits; voice, swallowing, or upper airway (collectively, speech) therapy; specialty referrals; imaging; and prescriptions. Structured prospective phone interviews were conducted for incomplete tasks and categorized as patient-level barriers, system-level failures, or process gaps.

A total of 335 patients with an actionable item were included (mean age 60.5 years, 55% female), yielding 625 total tasks. Overall, 133 tasks (19.9%) were not completed, corresponding to 91 patients (27.2%). Incomplete task completion rates varied by task type: follow-up (17.5%), speech therapy (25.2%), specialty referrals (32.6%), imaging (12.2%), and medications (13.4%). Among incomplete tasks with identified causes, 73.5% involved patient-level barriers and 26.5% represented system-level factors.

Approximately one in five physician recommendations following laryngology visits are not completed. Both patient- and system-level factors contribute to poor adherence. Targeted interventions addressing communication, referral workflows, and care coordination may improve adherence and patient outcomes.