Improving Healthcare Effectiveness by Understanding Patient Compliance

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Patient Compliance and Consequences of Non-Compliance

Patient compliance to treatment protocol has been a major issue in medicine. The problem was first reported by Hippocrates almost 2400 years ago.

Compliance indicates the extent to which a person’s behavior agrees with medical recommendations. In the context of drug therapy, compliance is the degree of agreement between the actual dosing history and the prescribed drug regimen. The main consequence of non-compliance is that patient condition does not get better or even get worse. Furthermore, he or she may have a relapse. Eventually, non-compliance can lead to increased morbidity, failures of treatment, more doctor visits and longer hospitalizations. Non-compliance has reached epidemic proportion.

It is estimated that medical costs due to non-compliance is estimated to be $100 billion annually. Every year 125,000 deaths are due to failures to adhere to treatments. In recent years, the number of studies reporting “drug compliance” has increased substantially and reached more than a 1000 every year (Düsing et al., 2001).

Strategies to Improve Drug and Patient Compliance

The general consensus is that drug compliance is particularly low, even in the setting of clinical trials. Even patients with severe chronic diseases also have a low likelihood of adhere to their treatment protocols.

For example, McNabb (1997) reviewed the attitudes of patients with diabetes with respect to their treatment and found the following: ·

  • Compliance to insulin injections varies between 20% and 80%.
  • Compliance to advice on diet is 65%, but compliance to exercise is only 19%-30%
  • Compliance to recommendations on monitoring blood sugar levels is 57%-70%

Several psychological models have been developed to understand health behaviors relevant to compliance. The most popular model is the Health Belief Model. The Health Belief Model postulates that health-related behaviors depend on 4 factors: perception of illness (which in turn depends on perception of susceptibility to illness and perception of severity of illness), perception of benefits of behavior, perception of barrier to behavior and health motivation.

Another popular model is The Theory of Planned Behavior developed by Ajzen and colleagues (1991). It was argued that the intention to perform an action depends on attitudes, subjective pressure and perceived behavioral control. To improve compliance, we need to develop a partnership between patients and physicians and nurses.

Strategies to improve patient compliance include

  • education,
  • improving communications with patient
  • teaching patients methods for self monitoring
  • use of electronic monitoring devices
  • physician follow-up (expensive method, but effective)


Haynes RB, Taylor DW, Sackett DL, eds. Compliance in Health Care. The Johns Hopkins University Press, Baltimore, 1979; 1-7

Incorporating Human Behavior in Healthcare Simulation Models, Sally Brailsford, Jennifer Sykes, and Paul Harper (University of Southampton)

Rainer Düsing, Katja Lottermoser and Thomas Mengden, Nephrol Dial Transplant (2001) 16: 1317-1321

McNabb W.L., 1997.Adherence in diabetes: can we define it and can we measure it. Diabetes Care 20:215-219.