Patient non-compliance can be like a roadblock on a well-planned journey. 

Even with the best maps and directions, if a patient doesn’t follow the route, reaching the optimal health destination becomes challenging and uncertain. It’s a clear reminder that the path to wellness takes teamwork; both the healthcare provider’s guidance and the patient’s commitment are crucial for a smooth journey.

But what happens when a patient doesn’t follow your recommendations or treatment plan?

Should you document their non-compliant behavior?

Will that affect your relationship with the patient?

Several questions and concerns that might be swirling in your mind. Let’s dive in and explore the reasons behind patient non-compliance, how it can impact you as a physician, and what steps you can take to manage it effectively.

What Is Patient Non-Compliance?

Patient non-compliance/non-adherence occurs when patients do not follow the physician's prescribed treatment plans or recommendations. For example, patients may miss or cancel follow-up appointments, fail to follow treatment plans, stop therapy or medications early, refuse specialist referrals or lab tests, or ignore safety policies or practice procedures.

Reasons for Patient Non-Compliance

Non-compliance is not always intentional. Patients often don't derail from a treatment plan by choice. Sometimes, there are other underlying reasons. Here are some factors that contribute to patient non-compliance:

• Lack of Health Literacy — Patients may struggle to understand medical information and instructions due to limited health literacy.
• Financial Constraints — The cost of medications or treatments can be a barrier.
• Language Barriers — Patients who don’t speak the same language as their provider may have trouble understanding instructions and following treatment.
• Poor Physician-Patient Relationship — A lack of trust in the healthcare provider or a poor relationship can affect adherence to treatment plans.
• Substance Dependence — Dependence on drugs or alcohol can interfere with following medical recommendations.
• Denial — Some patients may not believe they have a condition that requires treatment, especially in patients with mental health issues, leading to non-compliance.
• Side Effects — Adverse effects of medications can discourage patients from continuing their prescribed regimens.
• Lack of Support — Complex treatment plans can be overwhelming and difficult to follow without adequate support, especially for the older generation.
• Transportation Issues — The lack of reliable transportation can make it difficult for patients to attend appointments or get their medications.

How Does Healthcare Non-Compliance Impact Providers?

Healthcare providers are not immune to the repercussions of patient non-compliance.

According to the World Health Organization (WHO), nearly 50% of people in developed countries do not adhere to long-term therapy, and the situation is even more dire in developing countries. Patients who fail to adhere to treatment plans may experience suboptimal health outcomes and, in the worst scenario, severe adverse events, disability, or even death. The Office of the United States Inspector General estimates 125,000 deaths as a result of non-adherence to medical treatment.

Adverse clinical outcomes can incur significant economic costs due to overuse of practice resources. The need for additional treatments, follow-up visits, or emergency interventions drives up costs. On the other hand, complications from non-compliant behavior can result in lost workdays and impact productivity.

Furthermore, if an adverse event occurs, patients or their family members may file lawsuits alleging medical negligence, exposing providers to significant liability and financial risks. These events can strain the patient-provider relationship and negatively impact the practice's reputation.

Strategies for Managing Non-Compliant Patients

Picture designing an ideal care plan for your patient, only to discover they couldn’t stick to it. Frustrating, right?

Here’s how you can change that story and make a real difference in improving patient adherence and outcomes.

1. Identify Barriers

Most patients generally want to adhere to their provider's recommendations, but may hesitate to confess when they can't due to concerns about being judged or letting their provider down. This can lead to hidden non-compliance, which often remains unaddressed.

To effectively identify barriers, create an environment that encourages open and honest communication. Ask direct, empathetic questions to uncover potential obstacles such as cognitive impairments, emotional distress, or socio-economic challenges. For example, inquire if they are experiencing difficulties affording medications, transportation, or understanding the treatment plan.

If you suspect non-compliance, adopt a sensitive approach to address it. Reassure the patient that your goal is to support them, not criticize. Explain that understanding their struggles is essential for developing alternative strategies or solutions that better fit their needs. You can tailor interventions to improve adherence and outcomes only if you uncover the real cause of non-compliance.

2. Enhance Communication

Most patients want to be actively involved in their healthcare decisions. They want to understand their health conditions, explore treatment options, and participate in creating their care plans. This shift from passive to active participation can significantly improve treatment adherence. However, this is possible only if healthcare providers engage in effective communication.

Here's how you can improve treatment compliance with effective communication:

• Create a Collaborative Environment — Treat patients as partners in their care and make them feel their input matters. Encourage patients to share their preferences and concerns.
• Simplify Information — Use plain language and visual aids to explain conditions and treatment options, ensuring patients understand and feel confident in their care plan.
• Encourage Open Dialogue — Ask open-ended questions to uncover hidden concerns. Invite questions to clarify misconceptions and promote understanding.
• Leverage Digital Tools — Use patient portals, apps, and secure messaging to maintain communication and provide easy access to resources and medical information.
• Provide Clear Summaries — Offer written or digital summaries after appointments to reinforce understanding and provide a reference.
• Apply the Teach-Back Technique — Encourage patients to restate the key points discussed to verify their understanding. This technique helps identify knowledge gaps and reinforce key points.
• Respect Cultural Sensitivities — Cultural differences can often be the reason behind non-compliant behavior. Acknowledge diverse cultural backgrounds and values to build trust and improve patient engagement.

Treatment compliance is a personal decision. Healthcare providers cannot coerce patients to follow it. However, providers must ensure patients fully understand the benefits of the treatment and the potential risks associated with non-compliance. You can develop a patient care contract that clearly outlines the responsibilities of the provider and the patient, signed by each to confirm commitment.

3. Maintain a Meticulous Record

Documenting non-compliant behavior isn’t about judging a patient's character; it's about maintaining an accurate medical record of adherence to the prescribed treatment plan. It's an ethical obligation to ensure documentation is thorough and precise.

Additionally, when non-compliance leads to adverse events, comprehensive medical documentation is crucial in demonstrating that appropriate care was provided. Implement these documentation techniques in your daily processes:

• Document All Discussions — Keep a detailed record of every conversation with the patient, including treatment options, instructions, and advice given. GlaceScribe, an AI transcription tool, enables you to effortlessly capture every detail of patient interactions for accurate and efficient documentation.
• Obtain Written Confirmation — Request a signed agreement from the patient that outlines their understanding of the treatment's benefits, risks, and potential consequences and serves as evidence in the event of non-compliance.
• Record Instances of Non-Compliance — Accurately document all instances of non-compliance, such as canceled or missed appointments, failure to follow prescribed instructions, or non-adherence to medication regimens. Use ICD-10-CM code Z91.19 to indicate non-compliance with medical care and treatment. This ICD code helps track these occurrences within electronic medical records (EMRs) and provides a robust defense in the event of a medical lawsuit.
• Document Refusals — Record refusals by the patient, whether it’s rejecting a specific treatment, refusing to take medication, or declining diagnostic tests. Include the reasons provided by the patient, as well as any attempts made to address their concerns or offer alternatives.

4. Monitor Patient Progress

Monitoring progress is vital to ensure patients remain on track with their treatment plans. Ensure a timely follow-up, whether in person or over the phone, to monitor the patient's progress and address any recent concerns. The telehealth option would be a more convenient alternative that prevents no-shows. Document all follow-ups meticulously to track patient progress and adherence to their care plan.

Leverage apps or devices that help patients track their medications and monitor vital signs or symptoms. Likewise, work with patients to set achievable, short-term goals that lead toward their long-term health objectives. Celebrating small successes can motivate continued compliance.

Patient non-compliance can be prevented (to an extent) through a proactive and compassionate approach. Nevertheless, accurate documentation of non-compliant behavior is equally essential, as it safeguards your practice reputation and provides evidence of delivering optimal care. With empathetic engagement and thorough record-keeping, you can effectively address non-compliance issues and demonstrate your commitment to patient-centered care.