The Noncompliant vs The Non-adherent Patient

Noncompliant and non-adherent patients are two of the most common causes of treatment failure for chronic conditions. Studies show that providers are less accurate when diagnosing patients who demonstrate this type of behavior compared with patients showing more neutral behavior.

However there is a difference between a noncompliant patient and a non-adherent patient:

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  • Noncompliance: is generally a term which includes deliberate or intentional refusal by the patient (i.e. denial, depression, dementia, cultural issues, drug or alcohol dependence, cost of  treatment, frequent demander, questions provider’s competence, ignores provider’s advice, low expectations of support, threatening to the doctor, accuses the provider of discrimination). 
  • Non-adherence: is generally a term which includes unintentional refusalby the patient (i.e. patient is overwhelmed, does not understand, helpless, confused, and/or concerned with healthcare costs).

In order to identify why the patient is either noncompliant or non-adherent it is essential to ask open-ended questions including asking about possible obstacles in the way.

With any noncompliant or non-adherent patient, it is essential to ask and document the following:

  1. Provider recommendations. 
  2. Patient’s continued noncompliance or non-adherence (if possible, document in the “patients words” why they will not or cannot comply). 
  3. Provider efforts to help the patient understand the risks of not complying or not adhering to the provider’s treatment plan and advice.
  4. The patients inability to follow the treatment plan and advice.

Whether it is an issue of noncompliance or non-adherence it is essential that the provider and the patient, have a common understanding of the medical issue in question, the availability of effective medications, treatments or procedures for their issue, and the risks to the patient if the medical issue remains untreated or undertreated.

 

Sue Jones, BA, LVN, CPHRM
CAP Senior Risk Management & Patient Safety Specialist

 

If you have questions about this article, please contact us. This information should not be considered legal advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.