Organizations tackle compliance issue

The American Heart Association has estimated that patient non-compliance with physician instructions regarding medication use costs the United States $100 billion annually in unnecessary medical costs and lost national productivity.

"The cost of non-compliance, in terms of human lives and money, is shocking," said Martha Hill, former president of the American Heart Association.

Many factors affect compliance, including the ease with which a patient can incorporate a doctor's recommendations into his or her daily routine, the cost of medicine and medical care and the complexity of getting prescriptions refilled. In addition, a patient's perception can play a role in how he or she approaches complying with a physician's instructions.

"In asthma, for instance, there is a controller and [a] reliever medication that together work very effectively," said Patricia Wolf, manager of health management programs for Blue Cross of California. "But if you only take your reliever and not your controller, you're not working the medications effectively. So it's a lack of knowledge about how the medications work and how to use them."

The issue of compliance extends to preventative measures as well. For example, does a patient heed a doctor's advice about following an exercise program, quitting smoking or losing weight? "Compliance has to do with a variety of different behaviors that you want the [patients] to engage in in order to successfully manage whatever illness they have," said Wolf.

A multilevel challenge

Medical care providers are also involved in helping patients be compliant, whether it's following an established set of guidelines for treating an illness or doing something as simple as sending out appointment reminders. "My cat gets a pre-appointment reminder from the veterinarian to come and get the plaque scraped from her teeth," said Hill. "My car gets a pre-appointment reminder to get an oil change. We've known for years that sending out a pre-appointment reminder either by postcard or by telephone call more than doubles appointment-keeping."

Pharmacists also play a role in keeping patients compliant. "In grocery stores, the pharmacists have access to the patients," said Marilyn Standifer Shreve, past president of the California State Board of Pharmacy and chair of the consumer information and education committee. "Whether they take advantage of the opportunity is one thing."

Ensuring compliance

As the cost of health care becomes more of an issue nationally, many organizations are looking at ways to address the compliance issue. The American Heart Association has launched a multifaceted Compliance Action Program aimed at physicians, pharmacists, nurses, physician's assistants, health care organizations and patients. One element of the AHA's campaign is the Physician's Compliance Tool Kit, which includes educational materials that health care providers can use to teach their patients how to follow a health regimen.

This is very similar to the approach the California State Board of Pharmacy is taking to address the issue. That organization has published a series of monographs dealing with specific health topics, including pain management and women's health. "Our monographs go out to 150,000 health care providers in the state of California," said Shreve. "They address subjects of importance to the patients so we have tried to make them a little more simple, a little clearer than clinical jargon."

"The weight of the compliance problem cannot be placed on one group. It is very important that each audience – physicians, pharmacists, health care organizations and patients – share the responsibility," summarized Hill. "By making everyone aware of the compliance problem and by providing them with the information and tools they need, we hope to improve patient's health and save lives." PR