PHILADELPHIA — Noncompliance with physicians' orders “is a real problem” that costs the United States $100 billion annually and results in at least 125,000 deaths, said Reid Oetjen, director of graduate health services administration studies at the University of Central Florida.
At the annual conference of the Medical Group Management association, Dr. Oetjen said that there are three types of noncompliers:
▸ Unwitting noncompliers, who misunderstand their prescribed regimen or don't receive adequate information about the regimen. Language barriers and use of medical jargon may complicate matters. Sometimes, patients who receive bad news may not be able to process information presented to them.
▸ Unwilling noncompliers, who don't follow treatment orders because of economic, physical, or personal barriers—for example, a patient who can't afford a certain drug.
▸ Then there are the intelligent noncompliers, who make an intentional choice to alter their therapy without consulting their physician.
Physicians often overestimate the degree of correspondence between their orders and patient behavior, Mr. Oetjen said.
Compliance is problematic even with chronic or life-threatening conditions. A 2001 study of HIV protease inhibitor cocktails revealed that fewer than 50% of the patients took their antiretroviral medication correctly and on time. A too complex regimen was the source of the noncompliance among these patients.