Adherence to Professional Suggestions

As oral health professionals, we deal with diseases that result from patients’ lack of adherence to our clinical recommendations. If patients practiced excellent oral hygiene and showed up for suggested appointments, we would have little to do. However, human behavior being what it is, we all still have a job — and will for some time to come. This does not mean we should curtail efforts to help reduce and prevent chronic problems with dental caries and periodontal disease. Quite the contrary.

The first article I ever published dealt with the percentage of patients who came back in a timely manner for their periodontal maintenance visits. Over the eight years covered in the study, it was found that only 16% of these individuals returned as suggested. We spent a few years learning how to improve the rate of return and, ultimately, increased adherence to approximately 30%. We found we could increase compliance by informing patients of the importance of these visits and providing reminders by mail and telephone — and now, digitally.

It was true then, and is still true, the more acute and threatening the problem, the more crucial it becomes for patients to adhere to the recall schedule. However, even in acute situations, it is often true that one-third of patients will comply as suggested, one-third will comply sporadically, and the other third not at all. In contradistinction, individuals with chronic problems they consider minimally threatening (such as dental caries or periodontal disease) are even less likely to comply over time.

The more accurate and threatening the problem, the more crucial it becomes for patients to adhere to the recall schedule

Showing up for an appointment is one thing, but taking prescribed medication is another. Recent discussions about compliance with taking suggested medications include a comment from Phil Skolnick, PhD, DSc, former director of the National Institute on Drug Abuse’s Division of Therapeutics and Medical Consequences, who noted, “The University of Pennsylvania had a clinical trials outpatient center, and at one point the hedges out front were removed during landscaping renovation. What do think the workmen discovered? Dozens of bottles of investigational drugs that study participants were supposed to be taking and recording in their diaries.” I think we all have seen this in our practices.

In order to improve adherence to taking suggested medications, new high-tech approaches are being tested. The ideal method would require minimal effort from the patient, and the best tracking methods have no interactions with other drugs, food or supplements. To date, facial recognition using smartphones, breath analysis, and microchips attached to the medication itself have been tested. Most are in the early stages of development — and most are expensive.

What is the best approach to increasing compliance with clinical suggestions? First, recognize that it is a problem. Inform your staff and develop ways to inform your patients of the consequences of not adhering, then track the results. You will find that your patients will be healthier, and your professional job satisfaction will rise to new levels.

Thomas G. Wilson Jr., DDS
Editor in Chief

From Decisions in Dentistry. July 2018;4(7):5.

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