It is common for patients to be unwilling to take a prescribed medication or follow a prescribed treatment. They may not listen to your instructions, and they may even become hostile or precarious in their refusal – or hesitation – to submit. These situations can quickly escalate from a simple non-compliance to an active threat to the safety culture that behavioral health professionals want to create and maintain. The health belief model determines adherence based on the patient`s knowledge and attitudes.9 The four main concepts that determine a patient`s assessment of potential costs and benefits are not consistent with TABLE 2.10 • Patient and will not work with physiotherapy. Fred Kleinsinger, MD, primary care physician in the Department of Medicine at Kaiser Oakland Medical Center. He has an active outpatient panel practice, is a medical team leader for a group of 11 physicians, and leads the mentorship program for the medical department. Email: gro.pk@regnisnielk.derf. 1. Introduction to Haynes RB.

In: Haynes RB, Taylor DW, Sackett DL, eds. Compliance im Gesundheitswesen. Baltimore, MD: Johns Hopkins University Press; 1979. 2. Improving prescription adherence is critical to improving health care: taking medications as prescribed can reduce costs and improve health outcomes. Washington, DC: Pharmaceutical Manufacturers Association (PhRMA); January 2011. www.phrma.org/sites/default/files/1787/phrmaimprovingmedicationadherenceissuebrief1.pdf. Accessed February 1, 2012. 3.

Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence for treatment: three decades of research. J Clin Pharm Ther. 2001;26:331-342. 4. Exactly what the doctor ordered: taking the prescribed drugs can improve health and reduce costs. Washington, DC: PhRMA; March 2009. www.phrma.org/sites/default/files/1787/adherence1.pdf.

Accessed February 1, 2012. 5. Horne R, Weinman J, Barber N, et al. Concordance, adherence and compliance when taking medications. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO). December 2005. University of Leeds, School of Healthcare. www.medslearning.leeds.ac.uk/pages/documents/useful_docs/76-final-report%5B1%5D.pdf. Accessed February 19, 2012.

6. Bell JS, Airaksinen MS, Lyles A, et al. Concordance is not synonymous with compliance or adherence. Br J Clin Pharmacol 2007;64:710-711. 7. Dickinson D, Wilkie P, Harris M. Taking medication: Concordance is not compliant. Bmj. 1999;319:787. 8. Morris LS, Schulz RM.

Patient Compliance – an overview. J Clin Pharm Ther. 1992;17:283-295. 9. Griffith S. An examination of the factors associated with patient adherence and taking prescribed medications. Fr J Gen Pract. 1990;40:114-116. 10.

Chisolm SS, Taylor SL, Gryzwacz JG, et al. Health models: a framework for the study of adherence in children with atopic dermatitis. Clin Exp Dermatol. 2010;35:228-232. 11. Ried LD, Christensen DB. A psychosocial perspective in explaining patients` drug use behavior. Soc Sci Med. 1988;27:277-285. 12.

DeJoy D. Theoretical models of health behaviour and self-protective behaviour in the workplace. J Saf Research. 1996;27:61-72. 13. Eraker AG, Kirscht JP, Becker MH. Understand and improve patient adherence. Ann Intern Med. 1984;100:258-268. 14. Bond WS, Hussars DA. Detection methods and strategies to improve medication adherence.

Am J Hosp Pharm. 1991;48:1978-1988. 15. Red DL, Hall JA, Merisca R, et al. Effectiveness of interventions to improve patient compliance: a meta-analysis. Health care. 1998;36:1138-1161. The term “non-compliant patient” generally refers to a patient who intentionally refuses to take a prescribed medication or who does not follow the physician`s treatment recommendations. A non-adherent patient, on the other hand, refers to someone who involuntarily refuses treatment. This resistance can be due to various reasons, such as confusion, misunderstanding or overwork. Non-compliant behavior of patients often impairs the effectiveness of treatment for a variety of conditions and can have serious consequences. Most clinicians have little practice in identifying the most common causes of patient non-conforming behavior, and clinicians have few tools to deal with this type of behavior.

The objectives of this article are to define non-compliant behavior, discuss the most common reasons for non-compliance, and provide new information about non-compliant behavior that clinicians can use to develop more effective strategies for treating non-compliant patients. Over the years, various patterns of health behaviors have been described by many authors. Variables in these healthcare models can often be linked to predicting and understanding patient adherence. Self-reports and patient interviews are the most common and easiest methods of determining treatment adherence. Pill counting is another detection method used to measure adherence and is commonly used in clinical trials of drugs. A patient`s adherence to a drug regimen can be assessed by the difference between the number of dose units initially administered and the number of amounts remaining in the container during an unplanned revision or home visit. However, pill dumping (i.e., patients` attempts to distort their compliance by getting rid of drugs) is common, and several studies have shown that the number of returns significantly overestimates the actual compliance rate. Non-compliance and non-compliance of patients is known to be prevalent in psychiatric facilities, especially when it comes to patients who are not taking their prescribed medications.

For health care providers, it is paramount to remain calm and compassionate while doing their best to understand the cause of non-conforming behavior. One of the most common reasons for the patient`s non-conforming behavior is denial – the patient may not believe that they have a condition that needs to be treated. Known as anosognosis, this symptom affects many people with serious mental illnesses such as bipolar disorder and schizophrenia. These concrete steps will help you stay on track when managing multiple patients, needs, and instructions to maintain a high level of care in behavioral health care settings. At ObservSMART, we develop innovative health technologies for a variety of patient populations that help prevent sentinel events such as self-harm, suicide and runaway. • The patient is not compliant with smoking, which delays wound healing. In some situations, non-compliance is just that – a patient does not cooperate with recommended treatments. For example, smoking after surgery is a bad idea because it delays wound healing. If the patient ends up with a surgical wound that opens and becomes infected, this non-compliance would be detrimental to any potential medical malpractice. In this context, denial is the process by which painful or heartbreaking thoughts and problems disappear from consciousness – a very common reaction to bad news. Denial in benign forms is of considerable value – otherwise we would all be preoccupied with our problems and unable to function in our daily lives.