Dave Wendland

Lather, Rinse, Repeat

We’ve read these instructions thousands of times. But honestly, how closely do we actually follow them? 

There is actually humor inherent in these instructions if they are read literally. That is, if the instructions are followed exactly as written, the user will not know when to stop the process. In theory, a person could keep lathering and rinsing her hair until she ran out of shampoo. But this bit of humor really does mask a larger question: “How well do consumers follow instructions?”

Instructions all around us

In 1970 a rather annoying song called “Signs” was released by an obscure Canadian band called The Five Man Electrical Band. It’s a kind of parody song referencing a society filled with instructions, rules and guidelines. (And it’s one of those songs that once it gets into your head, it will likely stay there quite a while.) 

So what does that song have to do with healthcare? The lyrics are actually rather insightful. They point out that we are surrounded by signs (instructions), and we face consequences if we don’t follow the rules. However, because of the sheer amount of “noise” and the quantity of messages bombarding consumers each day, much of this communication is not heard — or, like the shampoo instructions, it’s ignored.

The issue of adherence 

In 1997 the World Health Organization defined patient adherence (also compliance) as the “degree to which patients adhere to medical advice and take medicines as directed. Adherence depends not only on patient acceptance of information about the health threat itself but also on the practitioner’s ability to persuade the patient that the treatment is worthwhile and on the patient’s perception of the practitioner’s credibility, empathy, interest, and concern.”

So here we are more than 13 years later, still struggling with how to convince patients of the importance of adherence. As cited in the March 2010 issue of Pharmaceutical Commerce and according to recently released findings from the National Center for Patient Information and Education (NCPIE, Rockville, Md.), 54 percent of U.S. adults do not take meds as instructed, either ceasing consumption early, skipping doses, or neglecting to get refills, among other actions. Yet 87 percent believe that prescribed meds will make a difference in their health. 

As the newly-passed Health Reform Bill begins to take shape and implementation is considered for various aspects, the issue of adherence must be addressed. The consequences of non-adherence are far too expensive and at the root of preventable hospitalizations and patient illness. CVS Caremark shared data at the 22nd annual meeting of the Academy of Managed Care Pharmacy (AMCP) estimating costs of poor medication adherence at a staggering $300 billion annually. 

Listen, then repeat

The problem is that current instructions encouraging compliance may be falling on deaf ears because of the lack of a two-way dialogue.  

Here is a case in point: It has been suggested that eight out of 10 phone calls, retail encounters, sales presentations, management interactions and service calls begin with prescribing a solution to a customer before the individual need is really heard, understood and validated. Repeating the reason a patient may be struggling with a prescription or care regimen before reiterating the original instructions and possible consequences is a step that is perhaps not being employed today. The result of this additional listening may lead to new insights and knowledge to drive an outcome that is tailored just for the patient. 

Perhaps truly listening to the concerns of the patient (or caregiver) regarding non-adherence will shed light on new and improved methods of communication. 

If instructions are shared in a manner that sounds like the song “Signs,” they may not be heard. Instructions that read like a shampoo bottle may not be believed. After all, consumers already feel they know better than the shampoo manufacturer, or that the manufacturer may have some hidden motive. However, if adherence were encouraged in a one-on-one manner and individual patients were heard and understood, it may be worth the extra time investment. 

The future of prescription compliance may depend on the ability to “Listen, Respond and Repeat,” one patient at a time.  

07/17/10