Understanding Adherence: 5 Questions Patients Want to Be Asked

Published August 2nd, 2021 | 3 Minute Read

Healthcare professionals and individuals with chronic health conditions understand that various factors can impact the level of adherence to a treatment plan, from lifestyle to side effects. Additionally, it’s clear that HCP relationships can affect a patient’s health journey, which may also impact adherence. Health Union’s white paper, Beyond the Treatment, Making the HCP-Patient Relationship Work: A Study Uncovering the Patient Perspective, explores those relationships in detail.

While it may seem like patients face a linear choice to either take their medication, like a “good” patient, or not take their medication, like a “bad” patient, it’s not always that simple. Furthermore, that thought process can be truly reductive of the hurdles patients may overcome to find a treatment plan that works for them. There are a variety of factors for HCPs to consider when communicating with patients. Factors that impact adherence include the patient-HCP relationship, from the time spent with HCPs to trust in HCPs, confidence in treatment, information regarding the medication, cultural beliefs, perceived severity, and health literacy. 

Open, non-judgmental communication between HCPs and patients can foster an environment in which treatment plans are optimally developed. When it comes to defining the different aspects of treatment, adherence means adequately filling prescriptions; compliance is taking medication as prescribed; and persistence is the amount of time a person is on a specific medication or therapy.  

However, the word “compliance” is not always well-received by patients, as it comes off as authoritative or militant; like a person of power is telling a patient what to do – and that they must comply. “Adherence” is often the preferred terminology, as it puts less onus on the patient. For more patient perspectives on the nuances of adherence, watch Health Union’s webinar: The Complexities of Adherence & Compliance

To better understand the various life factors that impact adherence, the following questions may help create a more open line of communication between patients and HCPs.

1. What has your life been like lately? 

Treatment plans tend to have a timed schedule. HCPs can open up conversations around the patient’s life as a whole and figure out what works for them and their lifestyle. For example, a medication that might be the “most” effective could have a rigorous administration schedule and side effects that don’t fit well into the patient’s lifestyle. Another medication may have a more relaxed administration schedule with fewer side effects that enable higher compliance and adherence. Treating a patient holistically, taking their whole life into account beyond their condition, might be the key to better compliance.

2. Do you have any questions about how to take your medication?

Treatment plans may involve a range of delivery mechanisms such as injections, either administered by an HCP or by oneself, devices like inhalers, pills, or other methods. It’s important to discuss the fit between the method of administration and the person’s lifestyle, not just the pharmaceutical side effects. For example, a common myth is that a person can take two “puffs” of an inhaler without a pause between or a spacing device. But actually, inhaler techniques can vary based on the patient and devices. Discussing medication administration could be a significant part of improving compliance.

Related Articles

Understanding Barriers To Needed Access to HCP, Specialist Care

For a number of reasons, people don’t always have access to the HCPs most attuned to their needs, which presents hurdles throughout their health journey.

HCP satisfaction

Relationship Advice: What Patients Want HCPs to Know About Satisfaction

Survey results and analysis from Health Union explore the nuances of the HCP-patient relationship and implications for the healthcare industry.

A person and their doctor

Cancer Patients More Satisfied With Doctors Than Autoimmune Patients Are

More than 8 in 10 cancer patients reported a high level of HCP satisfaction, while just over 6 in 10 patients with autoimmune conditions felt the same way.


3. Do you have any questions about why I’m prescribing this medication?

Perceived and actual severity are very different things. Patients may not understand why they’re being prescribed a medication that doesn’t match their perceived severity versus the clinical severity that an HCP noted. It’s extremely important that patients understand their symptoms on a clinical scale to understand their HCP’s rationale and hopefully be adherent to their treatment plan.

4. Has there been anything challenging about this treatment plan, from scheduling to side effects?

Many patients with chronic conditions, like asthma, are prescribed combination therapy, in which they take more than one medication. Keeping track of multiple medications might be challenging. If it’s known that a person living with diabetes has a busy schedule, it may be worth discussing once-weekly insulin injections for type 2 diabetes.

With longer-term HCP relationships, it’s important to have open and honest communication. People with chronic conditions may feel embarrassed about nonadherence or general difficulty in managing their treatment plan. But a healthy patient-doctor relationship can help address adherence without possible embarrassment. If a patient isn’t doing well on a current treatment plan, it’s more beneficial if they can advocate for themselves without fear of judgment. 

5. Do you have any questions? I have time.

Patients may feel rushed in their HCP appointments. Budgeting time in each appointment for open-ended questions may allow for patients to bring up feedback, both positive and negative, that can allow for a more curated treatment plan. In addition, these open-ended questions could provide patients with the space to share information that might be more adjacent to their health, like beliefs about medication, allowing HCPs to make deeply informed treatment decisions and share more information as needed.

A concern that patients might be hesitant to bring up is the cost of medication. Allowing time at the end of an open dialogue might encourage conversation around finances, from working with insurance or patient assistance programs. If possible, an HCP provider will work within a patient’s financial limits in order to provide affordable and sustainable care.

Final Thoughts on Improving Adherence

Adhering to treatment plans for patients with chronic illnesses can be understandably challenging. Up to 50% of patients who are prescribed medications for chronic conditions, like diabetes or hypertension, have issues with compliance. Nonadherence can have significant implications, with disease-specific meta-analyses showing an increased risk of complications and death in patients. For example, individuals with cystic fibrosis that have trouble with adherence may develop distal intestinal obstruction syndrome (DIOS), in which the small intestine gets blocked.

It’s important to remember that patients aren’t “failing” when they don’t optimally follow their treatment plan. Health Union’s research found that care, compassion, and communication had the potential to lead to a better HCP relationship, and possibly treatment plan. While factors like safety, efficacy, tolerability and cost are hugely important for both patients and HCPs, it’s incredibly important to remember that the patient voice is paramount in creating an optimal treatment plan. It’s up to both parties to create an environment in which their voices can be heard. 

Related Articles

Understanding Barriers To Needed Access to HCP, Specialist Care

For a number of reasons, people don’t always have access to the HCPs most attuned to their needs, which presents hurdles throughout their health journey.

HCP satisfaction

Relationship Advice: What Patients Want HCPs to Know About Satisfaction

Survey results and analysis from Health Union explore the nuances of the HCP-patient relationship and implications for the healthcare industry.

A person and their doctor

Cancer Patients More Satisfied With Doctors Than Autoimmune Patients Are

More than 8 in 10 cancer patients reported a high level of HCP satisfaction, while just over 6 in 10 patients with autoimmune conditions felt the same way.