Helping Patients Stick to the Plan

New book from RWJF Investigator Award recipient focuses on patient compliance with treatment.

    • June 23, 2010

It’s no secret to medical professionals that their patients do not always stick to their recommended treatment regimens. Indeed, research suggests that as many as half of patients do not fully comply with instructions for their prescription medications, leading to poorer health outcomes and higher health care costs. Non-compliance (also called non-adherence) isn’t restricted to prescription medicine. It’s also common for patients to fail to follow a broad array of regimens for preventing or treating chronic health problems like diabetes and hypertension.

What should medical professionals do to help their patients follow treatment regimens? M. Robin DiMatteo, Ph.D., 2005 Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research awardee and distinguished professor of psychology at the University of California, Riverside, notes that this question has gotten far too little attention from the medical community to date. “There’s been a half century of research on how to get people to follow their medical treatments,” she says, “but it’s not easy to make changes in the process of medical care, and in the ways in which people manage their daily patterns of health behavior.”

DiMatteo is co-author of a new book with Leslie R. Martin, Ph.D., and Kelly B. Haskard-Zolnierek, Ph.D., aimed at helping the medical community assist patients in adhering to treatment regimens. Health Behavior Change and Treatment Adherence: Evidence-based Guidelines for Improving Healthcare was published by Oxford University Press.

The book synthesizes the results of decades of empirical research on adherence and health behavior change, providing straightforward, practical guidance for health professionals. It describes a set of effective, evidence-based strategies to help patients put long-term behavioral changes into practice, and offers a number of clinical examples illustrating those principles.

It’s not easy for some patients to stick with a program, she explains. “The more complicated a treatment regimen is, the harder it is to adhere. Diabetes patients, for example, have to make changes in their diet and exercise patterns. They have to test glucose levels, take medicines, give themselves injections, and more. They get tired and frustrated, and they want a holiday from it. So we need a multi-faceted approach for those patients. They need a relationship with the medical team, constant reminders, and social support that makes them feel like they’re part of a group.” They also need to incorporate the lifestyle changes into their understanding of their own identities, she says. “They need to see themselves as people who successfully manage their diabetes throughout their lives.”

One big barrier to compliance is that many patients simply do not understand what is being recommended. “Half of the people who walk out of doctors’ offices couldn’t tell you what they were just told,” she says. Often, it’s because the information wasn’t communicated clearly. “I remember going to a doctor once and getting a verbal barrage of information. I finally had to ask, ‘is this some sort of cognitive test?’”

DiMatteo’s prescription? “Medical teams are really essential,” she says. “Doctors can’t do this alone. But if there’s an appropriate team approach involving a medical assistant, a nurse, an integrated strategy with pharmacists, that creates a successful environment.” She points to a recent New England Journal of Medicine article by David M. Cutler, Ph.D., and Wendy Everett, Sc.D., that highlights successful efforts by several medical systems. At Group Health Cooperative in Washington and Idaho, for example, nurse case managers interview patients to assess and increase adherence. They educate patients about their conditions and create patient-specific action plans. The Cooperative reports that the program has saved an estimated $476 per participant.

In fact, the potential cost savings are enormous. DiMatteo and her co-authors estimate that the price tag for noncompliance nationwide is as high as $300 billion annually. “If a person ends up back in the hospital, somebody pays for that,” she says. “If medical professionals don’t do more to help patients comply, then they’re set up for failure and a great deal of extra expense and suffering. So it makes sense to try to get everybody on board.”