Making adherence stick: It's not easy to get patients to follow directions

Patients' failure to follow physician recommendations is a well-documented link to poorer outcomes and higher health care costs, but strategies to address the problem remain elusive.

By Victoria Stagg Elliott, AMNews staff. Dec. 4, 2006.

Lisa M. Vinci, MD, a general internist in Chicago, is well aware of the challenge involved in motivating patients to follow treatment regimens and has developed approaches to urge them in the right direction.

For instance, she often repeats herself to make it more likely that her patients will take the medication she prescribes and follow her directions about making lifestyle changes. She collaborates with them to break larger goals into smaller, more achievable ones. She sends them to nurse practitioners if more intensive counseling appears necessary. And she even relies on family members to support the effort.

"I reinforce, reinforce, reinforce and go over and over again dietary recommendations and the importance of taking medication on a regular basis," said Dr. Vinci, also a clinical associate at the University of Chicago. "And I really negotiate with them and say, 'What can you do and what are you willing to do?' Then I work from that."

She is not alone.

Physicians often find themselves going to great lengths to make it more likely that patients will carry out a treatment plan. Patient nonadherence is a documented threat to health, blamed for costing thousands of lives and billions in health care dollars. It's bedeviled physicians for so long that Hippocrates even complained about it. And the American Medical Association adopted policy at its Annual Meeting in June stating that patient adherence is a necessary factor in achieving high-quality, cost-effective care.