Patient adherence is a pressing issue in the management of substance use disorders and other addictions. Overall, nonadherence (to all treatments) causes approximately 125,000 deaths annually in the US alone. Moreover, the forms of nonadherence extend beyond medication and include lapses in keeping appointments, to follow the recommended dietary or other lifestyle changes, and to follow other aspects of management-related advice. The rates of nonadherence continue to remain high in the past 30 years and new approaches have to be explored in order to improve that. Because a correct diagnosis and proper treatment are only useful for as long as the patient sticks with the treatment plan.
Healthcare providers can play an important role in assisting patients’ healthy behavior changes. Several approaches have been suggested to improve overall patient adherence/compliance, such as simplifying regimen characteristics, providing patient education, improving overall communication, etc.
In general, lifestyle-related behavior change is not easy for individuals. It requires a combination of all the above approaches. The complexity of a treatment regimen can be a factor that can negatively affect adherence. There have been efforts to simplify that by adopting a well-standardized approach. Drug regimens that have low frequency and less complex stages that can be introduced sequentially have yielded high compliance rates. It is important for physicians to use simple, everyday language and have the patient repeat the instructions to ensure proper understanding, with special attention given to elderly patients.
The next big challenge is to provide effective patient education by keeping the instructions succinct and simple, and supplementing oral teaching with written materials and involving the family whenever possible. For rehabilitation, in particular, it is worthwhile to address patients’ beliefs, intentions, and self-efficacy. It is important to understand how patients perceive themselves to be at risk, perceive their medical conditions to be serious, believe in the positive effects of the program, and are provided means to address their fears and concerns.
Patient communication is central to a successful rehabilitation program. At least 50% of patients leave their doctors’ offices not knowing what they have been told. Studies have shown that 50% of psychosocial and psychiatric problems are missed by physicians due to lack of proper communication. The physician needs to ask the patient about his/her feelings and concerns and encourage them to share in decision making when a plan for management is formulated. This provides a solid foundation for a successful collaboration with tailored strategies that best address the specific needs of the patients.
It is true that the individual’s level of adherence may vary over time and between different aspects of treatment, and the clinical team involved needs to pay special attention to such changes. Doctors tend to underestimate the problem of nonadherence in their patients, but it behooves them to evaluate patient adherence reliably, by way of self-reports, pill counting, and in some cases measuring serum or urine drug levels. An overall improved patient adherence goes a long way in ensuring the success of the rehab program, and it is something that requires special attention and a proper strategy to achieve.
