C is for Compliance -- and Can't

I was chatting with a friend, Donna, who is a nurse practitioner in charge of a diabetes clinic and teaching program. She probably knows more than most of the primary care providers in the office because they send her their most difficult patients.

“Difficult” means the patients are newly diagnosed, their disease is out of control and/or they are non-compliant.

And if they are of the non-compliant variety, they must suffer Donna’s wrath. She is a brutally honest, in-your-face East Coast Italian (with a heavy Boston accent) who lays it on the line with these patients.

“I say that if they aren’t going to do what I tell them, they might as well not bother showing up again,” she said.

Well, the truth is, they do come again, even when they aren’t doing all the things diabetics should do, and Donna tells them the same thing again and again. She’s also frustrated because her diabetic patients don’t attend the free classes held on a regular basis—although she knows some of the reasons. Many patients are low-income and don’t have the time because they must work, don’t have transportation or can’t find someone to watch the kids. And they tell her they can’t afford the food they should be eating and sometimes, the medications.

So compliance is a huge problem for Donna and for lots of nurses who see patients that just don’t do what they are told.

If that sounds like your situation, don’t feel bad. You're not alone.

A recent review of many studies over the years (published in The Cochrane Library) concluded that patients often don’t take their medications and that past research has produced no proven way to get them to do it—especially for long periods.

The review authors found that almost all of the more successful long-term strategies were complex combinations of “… more convenient care, information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up and supportive care.”

I certainly can’t think of any other ways to encourage compliance, can you?.

What problems have you had with patient compliance?

Do you have any tricks or methods that work?

What are some of the obstacles you've had to overcome to get patients to do what they are supposed to do?