HCP Solutions to Poor Adherence: Should Logic or Emotion Be the Focus?

By | April 2, 2014

When HCPs address issues of poor adherence with their patients, where should their focus lie? Should it be more on logic or on emotion? Here are a few thoughts about why emotion should be front-of-mind.

Two recent publications got me thinking again about the roles of emotion and logic in adherence-related decisions. This time from the HCP perspective.

HCPs Show Poor Adherence to Treatment Guidelines

A report from the Dartmouth Institute (see here) examined variations in prescription use for Part D patients across the U.S.A. Data for the report came from a 40% random patient sample for years 2006 to 2010. For analysis, the authors divided medications into three classes:

  • Effective – those with evidence of benefit
  • Discretionary – those of uncertain benefit
  • Harmful – those where risks outweighed benefit

In summary, the analysis found wide regional variations in prescription use. It also found:

  • Lower than optimal use of effective meds
  • Common use of discretionary meds
  • Higher than expected use of harmful meds

These wide regional variations together with sub-optimal usage of medications suggest poor adherence by prescribers to guidelines. But what causes this poor adherence?

When deciding how to address issues of poor adherence, should HCPs focus more on logic or emotion? Here's why emotion should take priority.What Drives Poor Adherence by HCPs?

Some answers to this question can be found in a Medscape article (see here).

The article commented that despite efforts to promote evidence-based guidelines, often these are not applied. Some 30%-40% of patients do not do receive care according to present scientific evidence, while 20%–25% of care provided is not needed or potentially harmful.

The paper concluded that poor adherence to guidelines was associated with doctors’ subjective characteristics. Doctor attitudes, beliefs, experiences, knowledge, skills, and values were all cited as playing fundamental roles.

So doctors tend to go with what they feel, not what someone else tells them. Perhaps sounds familiar? It’s just like patient reasons for non-adherence to medications – driven more by emotion (ie, feelings, experiences, and beliefs) than by logic.

Which leads me back to my last post (see here) and the roles of emotion and logic in decision-making. This suggested that:

  • Emotion has a major role in decisions
  • Emotion tends to take the lead in decision-making
  • Logic is then used as post hoc rationalization

So if emotion leads, how does this affect the way HCPs should go about improving poor adherence?

Applying Emotional Approaches to Poor Adherence

We’ve all been in situations where we’ve delivered a bulletproof, rational proposal. One that was so solid, there was no way it could be turned down. But then the other person says “no” and rejects our arguments. He or she just wasn’t swayed by our logic.

That’s because decision-making isn’t logical, it’s emotional.

A major slice of patient non-adherence is intentional. They choose to be non-adherent. These patients override rational arguments with emotional feelings, beliefs, and personal experiences. Just as doctors may do when choosing not to follow treatment guidelines.

Bombarding these patients with more facts and more logic is unlikely to win the day. HCPs need to communicate at a more personal, emotive level.

Spend a little time. Engage with these patients. All with the aim of discovering internal motivators that can be used to improve adherence. Maybe something they care a lot about, or something they want to achieve? Or maybe something “fun” that gets them away from negative thoughts associated with their condition?

Something they care enough about that they’re prepared to adhere to treatment to get there.

There are approaches available that can help HCPs do this (see here and here).