Are physicians misreading patient adherence?

All patients want to believe that their physicians have every aspect of their cases under control. In most cases, this is true - clinicians at every level study and train for the better part of a decade before they interact with patients, and every successive treatment is another opportunity to hone their skills. Coupled with advanced medical devices and surgical technology, it might seem like the modern physician has all the cards in his or her hand when it comes to safe and effective treatments.

While physicians and nurses may be excellent at shepherding patients through the various stages of clinical intervention, they may not be as familiar with aspects of care that take place outside of traditional inpatient settings. Doctors may give patients the most detailed discharge instructions in the world, but medical accuracy is unrelated to whether or not patients will actually remain faithful to medication regimens or exercise routines prescribed to them.

This issue of patient nonadherence has the potential to threaten multiple sectors within healthcare like pharmaceutical sales and quality of care metrics, and industry observers have continually called on clinicians to perform at a higher level now that it has become clear that patients' lives and the financial well-being of providers might be thrown into doubt with enough misbehaving patients. However, as a new survey from HealthPrize Technologies indicates, physicians might be categorically misrepresenting the problems of medication nonadherence from the ground level.

Are patients even reading discharge instructions?Are patients even reading discharge instructions?

Missing the mark
Many physicians like to stay up to date on new developments in the industry by reading peer-reviewed journals or attending conferences on various subjects. Despite this dogged determination to improve their skills, physicians may be turning a blind eye to the incredible rate at which their patients are not taking medications.

The HealthPrize Technologies survey contacted 100 physicians who primarily treat chronic conditions like diabetes, hypertension and high cholesterol. The doctors were asked questions related to their offices' performances regarding adherence, what strategies they have implemented to improve inefficiencies and if they personally participate in any adherence-improvement efforts.

The results indicated that, while physicians may have a very high sense of their own patients' adherence rates, the reality is much bleaker. The respondents almost unanimously rated adherence as a critical factor in clinical care - 97 percent listed it at least an 8 out of 10 in terms of importance.

"The respondents claimed that clinicians should not be held responsible as the sole party in charge of improving nonadherence rates."

Despite the acknowledgment, physicians misrepresented how their patients were sticking to medications. The respondents claimed that, of their patients, fewer than 10 percent of prescriptions were not filled or taken. However, the survey found that the actual number may climb as high as 15 or even 30 percent among this population.

"This is concerning, especially given the high rates of primary nonadherence, or failure to fill a prescription even once, and given that patients are at greatest risk of nonpersistence, or quitting therapy altogether, within the first few months," Katrina Firlik, M.D., chief medical officer at HealthPrize, said in a statement. 

Perhaps the most troubling part of the survey had nothing to do with patients and nonadherence rates at all. Though the physicians recognized the pressing importance of improving medication adherence, they claimed that clinicians should not be held responsible as the sole party in charge of improving these metrics. Moreover, 24 percent of doctors said they would not want to receive information on how their patients are adhering to medications, and 25 percent did not think access to such data would help them convince patients to stick to discharge instructions regardless.

Empathizing with patients
From the perspective of an overworked clinician, the survey results may make sense. Physicians work long hours and have to satisfy the clinical demands of their patients and the administrative and financial demands of their superiors. They may see so many patients in a certain day that following up during outpatient care may seem insignificant or unnecessary. Some doctors may even fail to understand what drives patients to go off of a medication plan.

Pain Treatment Topics explained that this misunderstanding may come about as a result of a disconnect between the physician and the patient perspectives. From the eyes of the clinician, medication is a natural extension of the treatments performed in inpatient settings. Patients followed instructions while they were admitted, so it is more than reasonable to expect them to perform the same duties in the comfort of their own homes.

However, many patients might be approaching medication from a wildly differing viewpoint.  First, PTT explained that some patients might see drugs as an indication that they are "damaged goods" - if they have to carry a bottle of pills around all day, this may damage their sense of self-reliance or embarrass them in front of friends and family. Moreover, many beneficial medications come with side effects that may make patients feel worse, albeit temporarily, than the conditions the drugs are meant to treat. This only strengthens the association between medication and weakness in many patients' minds.

Creative healthcare marketing can help patients of all ages.Creative healthcare marketing can help patients of all ages.

Breaking through
If physicians are misrepresenting the medication adherence activities of their patients and refuse to spearhead the effort to improve these failing rates, creative healthcare marketing solutions could be the critical link between patients and engaging medical information. 

Many patients are prevented from sticking to their doctors' discharge instructions because of ingrained psychological barriers against care, and creative healthcare marketing solutions that phrase complex medical information in terms that are culturally and linguistically accessible to all patients. Even younger patients who are more familiar with digital media can benefit from animations and short videos that explain the context of their conditions and why it is so important that they keep taking their prescribed medications.

If doctors are allowed to keep their heads in the sand regarding patient nonadherence, then it may be up to healthcare marketing to craft engaging and informative materials that patients can take with them after they leave the hospital.