Addressing Patient Non-Compliance

From Coverys Risk Management

Imagine yourself in the following situation:
It’s a typical Monday morning, and you’re reviewing the numerous reports and test results you received over the weekend. You are surprised to learn that one of your patients was hospitalized as the result of a stroke. Looking through your patient’s records, you recall that the patient had been seen the previous week with symptoms of dizziness and ear pain. At that time, the patient was given a prescription for prednisone, as you believed the patient was experiencing a second episode of vertigo. The patient's medical record also reflected your discussion about the risk of diabetics taking prednisone and the patient’s need to increase his insulin.

Knowing that the patient had a history of failing to follow instructions, you consider your recent care of the patient:

Did the patient understand the insulin dosing instructions?

Did the patient comply?

Could you have done anything further to reduce the risk of stroke or another negative outcome?

A scenario like this can occur in any physician practice. When patients don't follow an agreed-upon treatment plan, it can have an adverse effect on the patient's health and on your ability to help the patient manage his or her care. Non-compliance is particularly serious when it comes to prescriptions. According to a 2012 article published by Health Leaders Media, up to 30% of prescriptions go unfilled and as much as 50% of medications for chronic disease are not taken as directed. When patients don’t take prescriptions as prescribed, their illnesses may get worse, and costs of medical care can skyrocket due to unnecessary testing and avoidable hospitalizations.

Why do patients fail to follow a treatment plan? Some reasons may include: 
  • Lack of understanding of the treatment, due to a language barrier or the use of medical terminology
  • Denial of the illness, especially if the illness doesn’t interfere with their daily life (e.g., high cholesterol or high blood pressure)
  • Inability to afford treatment, due to high co-pays or a lack of medical insurance
  • Difficulty following directions (e.g., “take medication every three hours”)
  • Fear of the anticipated side effects from treatment (e.g., pain from knee surgery) preventing the patient from agreeing to the treatment
  • Misunderstanding the importance of a treatment or the likelihood of its success
Promoting Compliance and Minimizing Risk
Patients who fail to follow instructions or recommended treatment plans (by choice or accident/oversight) pose a risk to themselves and to you as their provider. How can you promote patient compliance and minimize that risk? The following strategies may be helpful:
  • Inform and encourage. Educate patients and family members about the patient’s medical condition or disease so they can effectively participate in the patient’s treatment and contribute to the patient’s healing process. Encourage patients to participate in developing their treatment plan to help them understand the reasons behind the plan, which may increase the likelihood that they will follow it. (See our blog article on shared decision making and patient engagement.)
  • Guide and listen. Provide clear instructions and ask for patient feedback to evaluate the patient’s interpretation and understanding. For instance, rather than telling a patient “to lose some weight,” consider providing a specific goal, such as losing 10 pounds by the next visit.
  • Spell it out … literally. Offer written instructions for patients to refer to later. Patients often don’t remember the verbal instructions they are given.
  • Empower. Establish guidelines for returning phone calls about prescription refills and lab results, and including patients in this process. For example, invite patients to call the office for lab results if they have not heard back from your office within a specified time frame.
  • Make it official. Obtain informed refusal from patients who admit they either can’t or won’t follow all or part of a proposed treatment plan. It is important to make sure that the patient’s medical record reflects these discussions, including the specific risks of choosing to forego a proposed treatment.
  • Chart it. Document all instructions and discussions held with the patient about a proposed treatment, including the patient’s response.
While patient non-compliance can pose challenges, you can help minimize risk of legal exposure while improving a patient’s health outcomes. Consider the many steps you can take to thoroughly educate your patients about the treatments you recommend and to create an environment of clear, encouraging communication that is as compassionate and engaging as it is practical and prudent.

No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances. 

Related Resources:

Coverys Risk Essentials

Video - 3/4/2019
These educational videos support improved patient safety and outcomes. Read More »

A Dose of Insight — Maternal/Fetal Risks: Using Claims Analysis to Improve Outcomes

White Paper - 1/8/2019
Each year in the United States, there are nearly 4 million births, and every birth has a story. This special report is the story of what can go wrong — the real data about maternal/fetal risk, why poor outcomes related to childbirth trigger malpractice claims, and what can be done to improve outcomes and reduce liability. Read More »

Behavioral Health Risks in Surgical Environments

Learn how to manage behavioral health issues in surgical environments and some nuances to consider for the surgical process. Read More »

Managing Behavioral Health Risks in the Emergency Department

Blog - 10/15/2018
Psychiatric admissions in EDs have reached an all-time high as the number of beds available for psychiatric inpatient services has dwindled due to changes in reimbursement for these services and other funding cutbacks. Learn how EDs can maximize safety and minimize exposures. Read More »

Seven Common Electronic Health Record Mistakes

Article - 1/10/2018
Improper use of electronic medical records may create a challenge in defending a healthcare provider’s treatment due to a perceived carelessness in documentation. Learn about seven common mistakes and how to avoid them. Read More »

Pennsylvania Supreme Court: Informed Consent Is a Non-delegable Duty

Blog - 8/30/2017
Pennsylvania Supreme Court opinion could significantly change the way physicians and surgeons address informed consent. Read More »

Telemedicine: Reducing the Risks

Article - 6/6/2017
An overview of the opportunities and risks of telemedicine for physicians and healthcare providers. Read More »

Surgical Claims Data: Inpatient/Outpatient Comparison

Blog - 5/26/2017
Key insights into the risks of inpatient vs. outpatient surgery from Coverys claims data. Read More »

Mitigating Surgical Risks in the Outpatient Setting

Blog - 5/26/2017
Tips to mitigate surgical risks in the outpatient setting, based on Coverys claims data. Read More »

Preventing Infection in the Outpatient Setting

Article - 5/22/2017
Many services traditionally provided in acute care and inpatient settings have moved to outpatient settings, such as surgery centers and physician offices. This article provides insight into what healthcare providers can do to prevent infection and improve patient safety in the outpatient setting. Read More »

Pediatric Lead Testing

Article - 4/4/2017
Tips to help healthcare providers enhance their pediatric lead screening and testing protocols. Read More »

Testing & Screening Tips for Pediatric Lead Poisoning

Blog - 4/4/2017
Lead toxicity among children in the United States has been a public health issue for decades and statistics show the problem is widespread. This article provides tips top help healthcare providers improve their lead screening and testing protocols. Read More »

Fragmented Intelligence Breeds Fragmented Care

News - 3/1/2017
Article highlights the importance of data analytics in uncovering the root causes of medical malpractice claims. Read More »

Medication Errors: The Risks We Must Reduce

Blog - 2/14/2017
A root-cause analysis of 11,000 medication-related claims reveals top areas of concern. Read More »

Legal Concerns Regarding Medical Record Alteration

Article - 12/19/2016
An actual case study is used to illustrate how altering electronic medical records after the fact can damage the defensibility of a malpractice lawsuit. Read More »

Shared Decision-Making & Patient Engagement

Blog - 12/15/2016
An overview of why patient engagement and shared decision-making is essential to successful patient-centered care. Read More »

Seven Tips to Increase Patient Engagement

Blog - 12/15/2016
Tips to help physicians and healthcare providers improve care through patient engagement. Read More »

Language to Encourage Patient Engagement

Blog - 12/15/2016
Insight into how the language you use when communicating with patients can help or hinder patient engagement. Read More »

Medical Assistant Scope of Practice

Article - 12/5/2016
To help ensure medical assistants are used safely and effectively in your office or organization you must clearly define their scope of practice. This article provides tips on how to do so. Read More »

Pros and Cons of Dispensing Medication Samples

Article - 11/21/2016
Outlines the pros and cons of dispensing medication samples and steps you can take to help ensure patient safety. Read More »

Tips for Responding to Negative Online Reviews

Blog - 11/15/2016
Tips to help you develop and implement a response plan to negative online reviews. Read More »

Preventing Healthcare Worker Fatigue

Article - 11/7/2016
Extended work hours bring up concerns of worker fatigue and its effects on patient safety. Learn strategies to help prevent worker fatigue and mitigate risk. Read More »

A Guide to Purchasing MPL Insurance

This guide provides important information about medical professional liability insurance coverage and points to consider when selecting an insurance provider. Read More »

How to Recognize and Respond to Zika

Blog - 9/2/2016
Tips to help physicians and healthcare providers recognize and respond to the Zika virus. Read More »

Communicating With Patients About Zika

Blog - 9/2/2016
How and what to communicate to patients regarding the Zika virus. Read More »

Reducing Zika Risk for Healthcare Providers

Blog - 9/2/2016
Identify and reduce risks to physicians and healthcare workers who treat patients with the Zika virus. Read More »

Exploring the Benefits of Root-Cause Analysis of Medical Professional Liability Claims

Article - 8/18/2016
The analysis of medical professional liability (MPL) data can offer a unique lens into a number of perspectives that are important to physicians and health systems. Most notably, it can provide intelligence to make the delivery of healthcare safer and ultimately reduce malpractice exposure for physicians and hospitals. Read More »