Neil Chheda, MD, assistant professor of otolaryngology at the University of Florida in Gainesville, realized a few years ago that nearly half of his patients on proton pump inhibitors were taking them incorrectly.
Explore this issue:November 2010
The issue of noncompliance extends to other areas of otolaryngology as well. “Patients don’t always follow through with the treatment regimen that is recommended,” Dr. Chheda said.
Continuous positive airway pressure (CPAP) compliance rates, for example, hover around 65 percent (Medical Care. 2004;42(3):200-209). Gastroesophageal reflux disease (GERD), chronic sinusitis, allergies and thyroid conditions can all be managed with medication, but chances are good that many patients are not taking their medications as ordered. In fact, over half of all Americans with a chronic disease admit to not following their physicians’ medication and lifestyle advice (American Heart Association. 2002. Statistics you need to know).
“If the patient doesn’t follow our recommendations, is it really a treatment failure, or is it a failure of the patient to follow recommended protocol?” Dr. Chheda said.
Dr. Chheda eventually found a solution to his compliance problem when he and his staff realized that those patients who received information from multiple sources were the most compliant. “Those who were being questioned by us and speech/language pathology tended to have higher compliance rates,” he said.
While Dr. Chheda relies on personal reminders to improve patient compliance, a host of communication devices, ranging from web-based medication reminder systems to “smart” pill bottle covers and electronic health record (EHR) systems with built-in reminder functions can call, text or e-mail patients. Some even report back to the physician—with the patients’ permission, of course.
Doctors, unfortunately, “know nothing about these systems,” said Brian Morris, MD, an internist and associate director of the Comprehensive Health Program at the University of California at Los Angeles (UCLA), which studies ways to help people adopt healthier behaviors. “As physicians, we tend to assume that what we tell the patient to do is what they’re doing, and that’s not always the case.”
—Neil Chheda, MD
Automating the Process
Studies show that electronic communications can be an effective method of increasing compliance. Researchers from Brigham and Women’s Hospital, Massachusetts General Hospital and the University of California found that text message reminders substantially increase sunscreen usage (Arch Dermatol. 2009;145(11):1230-6). In addition, physicians at Mount Sinai in New York have found that text message reminders increase medication compliance and decrease organ rejection in teenage transplant patients (Digestive Disease Week 2009: Abstract 175. Available at: http://www.ddw.org/wmspage.cfm?parm1=883).