Although the South African Patients National Health Charter states that it is the patient’s responsibility to follow treatment plans, when they choose not to do so, their actions may negatively impact the reputation of your medical practice, and end fatally for the very people you’re trying to help.

In essence, your patient’s responsibilities are still your problem.

In South Africa’s primary health care system, medication non-compliance is one of the physician’s main concerns.

This article looks at the reasons patients don’t follow treatment plans, and what medical practitioners can do about it.

Reasons for medication non-compliance

Non-compliance is a worldwide problem for doctors. The US National Library of Medicine reports that as many as 40% of patients fail to stick to treatment recommendations. 

When preventive or treatment regimes are too complex and especially if lifestyle changes are required, or any change of habits, non-compliance can be as high as 70%. 

For instance, patients with HIV/AIDS may be very motivated to comply, but their medication regimens are particularly complex, and often require multiple drug “cocktails”. 

Obese patients also have a high level of motivation to lose weight, but studies show that only a very few get rid of the weight and keep it off - because for most people, the actions that result in excess weight are compulsive habits that are hard to break.

As for the amount of medication needed each day… statistics show that medication treatment adherence rates drop as low as 20% when patients need to take thirteen or more pills each day.

In a study of patients who have hypertension, 59% of people followed the treatment plan when they needed to take meds three times a day. However, when the meds were to be taken only once a day, adherence increased to 84%.

Other reasons for patients failing to follow treatment plans are:

• Social and economic status
• Level of education
• Poor physician communication
• Patient depression or stress
• Financial obstacles 
• Unpleasant side effects
• Feeling tired of taking medication

Most South Africans who frequent medical practices are members of a medical aid, which for the majority, rules out financial issues (unless their medical aid schemes are exhausted of course), so it’s safe to say that medication non-compliance in medical practices, is mostly due to psychological factors, so we’ll focus more on that aspect than the other reasons.

Getting patients to follow treatment plans

1. Help solve their barriers

If the treatment plan is complex, don’t expect your patient to remember it. Have your administrative personnel create a page which details simple instructions, or even better, give it to your patient as a wallet card.

While helping your patients with solutions around complex regimens is not technically your job, by making it part of the patient experience, you will find a dramatic increase in medication compliance, and impress your patients while you’re at it.

2. Incorporate systems

Use medical software to build systems that automatically remind patients of repeat prescriptions by SMS, or to remind them to take their medication.

You could also schedule follow-up appointments and get a nurse to spend time with your patients, going over treatment plans, finding out how things are going, and reinforcing medication and treatment compliance.

Alternatively, someone from the practice could call patients to remind them. There is also software available that can be incorporated into your systems.

3. Take time to educate

Professor Ashraf Kagee from the University of Stellenbosch, focuses specifically on the mental health of people living with HIV as well as the psychological factors influencing adherence to antiretroviral therapy, says that in medical studies, a 

“higher level of adherence was associated with higher education, higher perceived self-efficacy and higher knowledge of treatments and consequences of poor adherence.”

As the medical practitioner, take the time to educate the patient about their illness or disease, and explain the consequences of not adhering to the treatment plan, such as:

• Wasting medication and money
• Progression of the disease
• Decrease in functional abilities
• Lowered quality of life
• Hospitalisation
• Antibiotic resistance

4. Consider printing booklets

When patients face a change in lifestyle, they will need a lot of motivation to stick to a treatment plan.

The good news is that on diagnosis, most patients are keen to learn more, so providing a printed booklet that educates, may prove successful. Be sure to keep it simple - get a layman to design understandable, simple, graphics instead of using complex words.

5. Involve caring family members

When you have built relationships with your patients, you will know if they have a caring support structure. If so, schedule an appointment with the family to discuss the importance of adherence to treatment.

Remember to communicate extensively about the negative effects of medication, how to use it, why it’s important, and what can happen if it’s not taken.