Aren't WE the compliance professionals?

I recently read Robert Cialdini’s seminal text Influence on the psychology of persuasion and was struck by a phrase he used the “compliance professionals.” In using this term, Cialdini was referring to a diverse group of professionals including salespeople, fundraisers, recruiters, advertisers, marketers, and others who make a living convincing people to say “yes”. While these folks undoubtedly rely on their ability to convince others, I was still left a bit dumbstruck. After all, aren’t WE the compliance professionals? An essential part of our remit as health professionals is to help our clients follow and benefit from their treatment regimens. As former US Surgeon General C. Everett Koop said in 1985, “Drugs don’t work in patients who don’t take them.” Read: Bariatric surgery for the prevention and treatment of type 2 diabetes Medication nonadherence is complex and multi-faceted. There are any reasons why clients may not follow their treatment regimens as intended: cost, adverse effects, complex regimens, mental health issues, fear and worry, not understanding benefits of treatment, or even just plain forgetfulness. Ok, ok. I hear some of you saying that’s because we promote the much friendlier and person-centric “adherence” over “compliance.” Adherence is more positive and proactive and honours our clients’ autonomy. But can we honestly lay claim to being the “adherence professionals”? A 2015 survey by the Canadian Pharmacists Association indicated that 30% of people stopped taking medication before they were advised to, 26% elected not to fill a prescription they were given and 26% took less medication than they were instructed to take. Other studies suggest that approximately 50% of medications for chronic disease are not taken as prescribed. And the impacts are huge. One study attributed 5% of Canadian hospital admissions, 5% of physician visits and $4 billion annually in direct healthcare costs to medication nonadherence. When we consider adherence to lifestyle recommendations, the statistics are even worse. Only 49% of Canadian adults meet the recommendation of 150 or more minutes per week of moderate-to-vigorous physical activity. Given the increasing rates of overweight and obesity in our country—up to 60% of Canadian adults can now be described as overweight—nutrition advice isn’t being consistently followed either. So, why aren’t our clients listening to us? Read: Strategy 101 for your pharmacy practice As social and technological changes shift our profession over the next few years, we need to ask ourselves some hard questions about what unique value we offer that will not be easily displaced or replaced. Most dispensing tasks? Automation does it quicker and more accurately, or soon will. Interaction checking? As AI tools scale up, software applications will be able to consider more variables in more permutations than any human can. Read: Drug news—May Big tech and big data are coming to disrupt healthcare in ways that many of us can hardly fathom. So, we need to find vital challenges within the health and wellness ecosystem that we have unique skills, ability, experience, and placement to address. What we as a profession must offer goes beyond the five R’s: right patient, right drug, right dose, right route and the right time. The statistics I’ve shared above demonstrate that this simply isn’t enough, in the same manner various ways of saying “eat less, move more” isn’t helping clients achieve a healthy weight. What we as a profession need to do is make a shift from merely educating our clients to coaching them for success. We need to become experts in behaviour change as much as we are experts in pharmacotherapy. Coaching recognizes that the most important barrier clients face is not knowledge about WHAT to do but rather HOW to do it. And how to keep doing it, day-in, day-out. Read: Our treatment navigation feels stuck in the '60s Where teaching is focused on imparting knowledge and enforces a hierarchy between instructor and learner, coaching is a partnership focused on skill acquisition and development. Coaching is client-centric, meeting them where they are at and helping them reach goals that are meaningful to them. Coaching is about drawing out the skills and abilities already resident within our clients. This isn’t to say that education is no longer necessary. It is necessary but not sufficient. We need to recognize that the issue isn’t with our clients, it’s with us and our approach. If we want to become the “adherence professionals,” we need to adopt new methods that focus on delivering what our clients need, instead of on what we are accustomed to providing. We need to understand what our clients value, what their goals are and what are the key barriers to them getting there. And if we don’t, it’s not just our clients that lose out. Our profession’s future is also at stake.

Aren't WE the compliance professionals?

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