Patient compliance is an ongoing problem.

A study we conducted of 257 physicians nationwide revealed that 0% keep track of their patients' compliance rates. Of 6 specialty medical associations we contacted, including those from cardiology, gastroenterology, bariatric physicians, and primary care, none were able to provide national statistics on compliance. One of the directors we spoke with told us, "I don't think any of our members keep track of compliance. We just figure if patients don't come back, they're doing fine."

Most people assume that it is the patient's job to follow through on their physicians' recommendations and the assumption is that they will do so.

But if patients actually did that, we would see a significantly lower percentage of the population with health problems such as obesity and diet-related diabetes and high cholesterol. Wouldn't we find fewer people smoking or abusing alcohol, illegal drugs and prescription medications? As doctors already know, a significant number of patients aren't following doctors' orders.

It turns out that patient compliance is directly influenced by the degree to which clinicians intervene on behalf of the patient. In a study we conducted of 300 clients enrolled in a commercial weight loss program, those who participated in a strategically designed interview process were significantly more likely to achieve and sustain their weight loss goals than were those who underwent the "standard" process.

Clinician Intervention Makes an Impact

Clients were randomly divided into 2 groups:

Group 1. Standard process: 150 clients received individualized, 15-minute sessions each week during which they were weighed and measured and discussed menu choices for the following week; and

Group 2. Research group: 150 clients received a 6-minute interview (see below) on their first day. From that point onward, each client received the same process as Group 1 with 1 exception: Group 2 clients were reminded each week of the responses they gave during their initial interview.

As a result, only 32% of Group 1 achieved and maintained their weight loss goals for 12 months compared with 84% of Group 2.

Patient compliance occurs as a direct result of patients' motivation, ability, and willingness to take and sustain effective action. The more difficult or uncomfortable the action is, the more the patient must obtain "Desire," "Resources," and "Permission:"

DESIRE. The degree to which patients have a desire to overcome their health challenges. In short, they have to want what they will get as a result of following doctors' orders. For example, a patient may want to have clear sinuses, but may not want it badly enough to use nasal lavage.

RESOURCES. No matter how badly patients may want to get healthy, they have to be able to follow through on their doctors' recommendations. Lack of sufficient resources such as money, time, family support, transportation, and health can block a patient's ability to do what is required for compliance.

In addition, we have often found that lack of compliance comes as the direct result of lack of understanding. During an onsite training program, this consultant discovered that 98% of interviewed cardiology patients couldn't explain their doctors' treatment recommendations, even though they had received written instructions from their doctors.

PERMISSION. The most complex and overlooked component of patient compliance is the degree to which action is blocked because the patient isn't willing to change. While there are many factors that inhibit permission, the most common are fear; anger; lack of self-esteem; and insufficient trust for the doctor, staff, facility, medication, or procedure based on their or others' opinions.

From Medscape Business of Medicine

Wendy Lipton-Dibner, MA