Making Outpatient Care of Diabetes More Efficient: Analyzing Noncompliance

Two recent brief articles^1,2 in this “Business of Diabetes” department focused on common issues that may worsen clinical outcomes of outpatient diabetes care and make the care process more prolonged and complex. These issues were depression and borderline personality disorder, and both are examples of a multitude of problems that result in the failure of diabetic patients to adhere to the medical prescription for their condition. The effort to deal with the negative consequences of noncompliance prolongs the outpatient visit and makes service more complex.

Perhaps no aspect of outpatient diabetes care seems as frustrating to primary care providers as the problems that result in nonadherence. In our program, we have developed a menu of brief, simple assessments to identify the factors that contribute to this overall problem.

“Nonadherence” Versus “Noncompliance”

Some years ago, diabetes educators argued that the term “adherence” be used preferentially instead of “compliance,” and the term “nonadherence” be substituted for “noncompliance.”³ The rationale for this proposal was that the term “noncompliance” implies a series of negative value judgments about patients as people. Instead, the term “nonadherence” was thought to imply a description of a failure to follow the medical prescription without any bias toward the patient as a person. Most authorities have endorsed this view.⁴ In addition, specific studies have noted that nonadherence may entail various components that may relate to flaws in the process of care and that do not entail a failure on the part of the patient.^5,6

However, much of the medical community has never adopted this concept, and in many other areas of clinical practice, the term “noncompliance” remains the standard description of this adverse patient behavior.^7,8 In diabetes care, the concept of “noncompliance” with associated innuendoes, remains prevalent.^9,10It …