Why People Are Noncompliant with Treatment

Table of Contents
View All
Table of Contents

Patient compliance, sometimes called adherence, is how healthcare providers describe your ability to follow through on the care they recommend. It's the part of the partnership that relies on you to treat an infection, manage a chronic illness, or meet your weight loss goals.

What providers already know is that not everyone will visit the specialist to which they've been referred or have a pharmacist fill their prescription and take it as prescribed. Researchers study the reasons for why people don't follow their care plans and hope to improve compliance with care.

This article explains the patient compliance problem and factors that contribute to it. It presents some of the study findings on how to help people better adhere to treatment, and the steps you can take to become a better partner in your own care.

Man holding pill medication
Paul Bradbury / Getty Images

Research on Noncompliance

According to the World Health Organization (WHO), approximately 125,000 people with treatable ailments die each year in the United States because they do not take their medication properly. The WHO also reports that up to 25% of hospital admissions result from noncompliance.

Not taking medication as prescribed can account for up to 50% of treatment failures. Studies back up the prevalence of patient noncompliance. A 2016 study found that a third of people living with kidney transplants don’t take their anti-rejection medications.

An estimated 50% of people with cardiovascular (heart) disease and its major risk factors have poor adherence to prescribed medications.This failure can lead to additional health complications.

When people don't follow through with the treatment decisions they have made together with their healthcare providers, it can cause additional problems. They may not get over their illness or injury. They may get sicker, injure themselves further—or worse.

The Numbers on Drug Adherence Failure

Some 3.8 billion prescriptions are written each year in the United States, according to the Centers for Disease Control and Prevention. About 20% are never filled. Of those that are, 50% are not taken correctly. The impacts of not complying are expensive in terms of both lives and health care costs, which can run up to $300 billion annually because of medication failures alone.

Reasons People Don't Comply 

People don't adhere to their treatment plans for quite a few reasons, and researchers seek to understand why they fail to take medication or stick with an exercise regimen. The World Health Organization identifies five dimensions with factors that may lead to these failures:

  • Type of diagnosis
  • Type of therapy
  • Socioeconomic challenges and cost concerns
  • Individual traits, including memory and other cognitive challenges
  • Healthcare providers and insurance systems

Type of Diagnosis

People sometimes act in denial when they don't experience symptoms with a condition such as high blood pressure (sometimes called the "silent" killer), or when they minimize the impacts. They also may express denial in the face of a potentially fatal diagnosis such as cancer.

For some, if you don't believe your treatment is going to make a difference in your health, you may not be motivated to comply. This can lead to apathy about your treatment. A lack of trust can occur, too, when people are reluctant because they complied with treatments in the past but they haven't worked.

Type of Therapy

The type of therapy can affect whether people comply with care, just as the diagnosis does. One study of patient compliance found that people living with a cancer diagnosis were concerned about unpleasant side effects of chemotherapy, radiation, and other cancer care therapies.

Any perceived negative— the side effects of medicine, the prick of a needle, or the pain of physical therapy—may keep you from following through.

Socioeconomic Challenges

One study of 500 people treated for high blood pressure and diabetes found their compliance decreased when they couldn't afford travel to appointments. The same study found that if new medications or changes in diet were prescribed, people were more likely to comply if the drugs and foods were affordable.

Other factors, such as level of education, affected the ability to understand the condition and treatment plan. Even issues like the social stigma of living with human immunodeficiency virus (HIV) make it harder for some people to keep their appointments and take their medication.

Individual Traits

Some people may have cognitive or behavioral challenges that make compliance with care difficult, or they're entirely dependent on others to provide that care. Others may simply be resistant to intervention.

A literature review of therapeutic exercise for people living with Parkinson's disease found many individual traits that affect people's ability to comply, including their expectation about outcomes and their existing levels of depression or anxiety.

Issues like remembering to take medication or being able to open a "child-safe" container can create barriers for many people. Support systems and competent caregivers make a difference in their ability to adhere to treatment.

Healthcare Providers

People who are engaged in their care, and supported with patient education and other measures, tend to stick to therapy better. Without access and communication, it's hard for people to comply with care.

Healthcare providers play an important role, as do telehealth and monitoring services. One study from Germany followed 1,000 people who were new to positive airway pressure (CPAP) treatments for sleep apnea and related conditions. Half of them were guided via telemedicine, while the other half received daily updates with data monitored while sleeping.

The study found the patient engagement group who received the daily data updates used their devices more reliably and weren't as likely to end their CPAP use.

What Can Be Done?

Healthcare experts continue to study the reasons behind patient noncompliance and are working to find solutions on their end. If you are a person who finds it difficult to adhere to your treatment plan even though you'd like to, here are some things you can do that may help:

  • Ask questions: If you don’t fully understand how or when to take your medication, or the reason for a change in your diet, ask your healthcare provider or your pharmacist for help. Ask a friend or loved one to go with you to listen, help you, and take notes if needed. The FDA has information on how to take medications as prescribed.
  • Get a pill container: Many types of pill containers are available at drugstores. Some are divided into sections for each day of the week and time of the day. Some pharmacists will even prepare blister packs for daily or weekly medications.
  • Keep a "health calendar": You can use a calendar to keep track of appointments and therapy sessions, as well as taking medications. For example, you can make a checkmark every time you take your dose. You can track these on a phone or digital calendar, too.
  • Tell your healthcare provider if paying for prescription drugs is a problem: Your practitioner may be able to prescribe a generic medication or offer other suggestions to offset the cost of a drug. Generic drugs can cost 80% to 85% less. Some pharmaceutical companies also offer assistance programs for those who qualify.
  • Health technology can help: Some devices are designed to help people adhere to a medication or exercise schedule. There are pagers and wristwatches, automatic pill dispensers, and even voice-command medication managers. You can also set alarms on your smartphone. Ask your pharmacist for suggestions as to which particular devices may be helpful for you.

Work With Your Healthcare Provider

If you don't plan to follow through on your treatment, or you're not successful in doing so, contact your healthcare provider to share your reasons. Together, to the extent it's possible, you may work out an alternative you both can agree on. Remember that noncompliance can have dire consequences.

Summary

Some people find it hard to follow through on the instructions and treatments of their healthcare providers. This patient noncompliance, or lack of adherence, can lead to health issues that don't go away, get progressively worse, or even prove fatal.

Patient noncompliance is a complex issue with many contributing factors. Someone with advancing dementia may not be able to keep up with daily medications; a much younger person who needs physical therapy may not have transportation; or, a person living with cancer may feel as though they've given up on treatment.

Researchers continue to identify ways to help people to be partners in their own care. Talk to your healthcare provider about the best ways to be successful in meeting your health and wellness goals.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Kim J, Combs K, Downs J, Tillman F. Medication Adherence: The Elephant in the Room. US Pharm. 2018;43(1)30-34.

  2. Patzer, R, et al. Medication understanding, non‐adherence, and clinical outcomes among adult kidney transplant recipientsClinical Transplantation. 2016;30(10):1294-1305. doi:10.1111/ctr.12821 

  3. Kronish I, Ye S. Adherence to Cardiovascular Medications: Lessons Learned and Future DirectionsProg Cardiovasc Dis. 2013;55(6):590-600. doi:10.1016/j.pcad.2013.02.001

  4. Centers for Disease Control and Prevention. CDC Grand Rounds: Improving Medication Adherence for Chronic Disease Management—Innovations and Opportunities.

  5. Peh KQE, Kwan YH, Goh H, Ramchandani H, Phang JK, Lim ZY, et al. An Adaptable Framework for Factors Contributing to Medication Adherence: Results from a Systematic Review of 102 Conceptual Frameworks. J Gen Intern Med. 2021 Sep;36(9):2784-2795. doi:10.1007/s11606-021-06648-1.

  6. Parra DI, Romero Guevara SL, Rojas LZ. Influential Factors in Adherence to the Therapeutic Regime in Hypertension and Diabetes. Invest Educ Enferm. 2019 Sep;37(3):e02. doi:10.17533/udea.iee.v37n3e02

  7. Schootemeijer S, van der Kolk NM, Ellis T, Mirelman A, Nieuwboer A, Nieuwhof F, et al. Barriers and Motivators to Engage in Exercise for Persons with Parkinson's Disease. J Parkinsons Dis. 2020;10(4):1293-1299. doi:10.3233/JPD-202247. 

  8. Woehrle H, Arzt M, Graml A, Fietze I, Young P, Teschler H, Ficker JH. Effect of a patient engagement tool on positive airway pressure adherence: analysis of a German healthcare provider database. Sleep Med. 2018 Jan;41:20-26. doi:10.1016/j.sleep.2017.07.026. 

  9. American Heart Association. Taking control of your medications.

By Trisha Torrey
 Trisha Torrey is a patient empowerment and advocacy consultant. She has written several books about patient advocacy and how to best navigate the healthcare system.