BEST PRACTICES

Patient compliance: Start the conversation

Help patients better understand how to care for their wounds at home.

Nurse speaking with elderly female patient in wheelchair.

Patient noncompliance isn’t just an issue in your facility. It’s a worldwide health care epidemic. According to the World Health Organization, approximately 125,000 people in the United States alone die each year because they fail to take their medication correctly.1 Why don’t patients adhere to treatment regimens? There are many reasons, often all at the same time. Responding to these reasons can save lives as well as money. It has been shown that for every dollar spent improving patient adherence, seven dollars are saved in total healthcare costs.2

Here, we spell out seven reasons why patients don’t adhere to treatment and offer ways to encourage adherence.

What are your patients thinking?

“I don’t understand.”

How to help:
You might start by sympathizing with your patient about the complexity of treatment and its newness to them. Then, try to simplify your explanation of what the wound is, why the wound needs care and the improved quality of life by adhering to wound treatment. “Patients are often overwhelmed with just getting the milk into their cereal with shaky hands some mornings,” says Medline Clinical Education Specialist Katie James BA, RN, CWCN. “We need to make things simple with easy-to-understand instructions—think 3rd grade level—and pictures,” she says. Someone on the nursing team might also ask the patient to explain the instructions back to her, which allows the nurse to fill in any gaps and answer any questions. Providing simple written instructions to take home can reinforce this discussion.2 If the patient is required to purchase any wound care products, it’s important to explain what the benefit is for the patient.

“I can’t afford it.”

How to help:
As the cost of health care keeps rising, affordability for treatment is a real concern, but patients don’t always mention it.4 “Pride is often a huge obstacle in asking for assistance, but between social workers and reaching out to manufacturers, patients do have assistance, even when their resources are limited,” James notes. It’s helpful to remind your patients that there are resources out there; a printed handout of these resources could avoid any embarrassment your patients may feel asking about them.

“It’s inconvenient.”

How to help:
Transportation is a known barrier to health care, often more prevalent in rural areas or for non-white and lower income populations. 5 However, with many on-demand transportation services available, patients should find it easier to make it to pick up wound care supplies and adhere to treatment checkup appointments. “A lot of patients just need to learn how to use the app,” says James who also points to multiple delivery options, including by pharmacies. If patients feel uncomfortable with strangers driving them, it may help to encourage them to reach out to a family member.

 “I don’t need this.”

How to help:
As James says, “This one is tough,” because it indicates your patient may be in denial about the consequences of noncompliance. She urges nurses to be persistent. Two tactics are helpful here. First, present the treatment through your patient’s eyes. So instead of telling them what you want them to do, tell them how much better they will feel when they follow treatment. It’s also helpful to involve patients in planning their treatment regimen3, despite some medical professionals’ resistance to giving up control.6 It’s about shared decision-making, allowing time and energy for each patient to become a partner in his treatment, assuming you adequately educate your patients on their wounds and treatment.7

“I forgot.”

How to help:
Wound care treatment can be like good advice: It’s easy to offer, not as easy to follow. Keep that in mind when you create a treatment regimen for your patient and offer tools such as paper or digital charts or calendars for patients to keep track of what they do when.3

“It’s not helping.”

How to help:
“Patience and gentle understanding of their frustrations is pretty important here,” James says. “We all want to take a pill and get better, but patients have to remember that they did not get that way overnight and, while modern medicine is awesome in its capabilities, it just is never a miracle overnight success, regardless of what the late night informercials and Google say.” Margaret Halstead, Medline VP Health Economics & Market Access, would give patients a short-term goal rather than a far-off outcome of improvement. When patients asked her how long it would take for a wound to heal, she said to give her 48 hours. She’d measure the wound on the first day, then tell the patient to follow the treatment plan for 48 hours and she’d measure again. “When patient sees an outcome with products that work, they will then give you the effort to match, because they realize that for the effort they’re expending, they’re going to get a return on that investment,” Halstead says. “So, all of a sudden, it’s not the depressed, pessimistic person, but someone that’s now engaged in their outcome.”

“I don’t trust you.”

How to help:
It can be frustrating when patients don’t follow treatment plans, but building trust in that treatment starts with trusting the medical professionals. “The patient is more apt to be compliant and engaged in that plan of care if they feel confident in the nurse and feel a sense of trust in that nurse,” says Patricia Turner Director of Clinical Services, RN BSN CWOCN. “Patients are not going to be as open to answering questions or allowing examinations if they don’t feel some sort of trust by the nurse,” she says. Building that trust stems from patients won’t always tell you that, and confronting them blame- or shame-heavy questions probably won’t help. Shame or fear may cause them to pull back2 rather than sharing with you more personal information that may be preventing them from adhering to treatment.

References:

  1. https://www.who.int/chp/knowledge/publications/adherence_report/en/
  2. https://www.ama-assn.org/delivering-care/patient-support-advocacy/8-reasons-patients-dont-take-their-medications
  3. https://www.uspharmacist.com/article/patient-compliance-and-health-behavior-models
  4. https://www.pgpf.org/blog/2019/03/why-are-americans-paying-more-for-healthcare
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265215/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800278/
  7. https://catalyst.nejm.org/shared-decision-making-good-clinical-care/