How to solve non-compliance in the NHS

Dr Tim Ringrose, CEO of Cognitant Group explores the issue of non-compliance within the NHS and how technology can help combat this growing issue. 

Non-compliance in healthcare has cost the NHS an estimated £300 million. With over 50% of patients not taking medication as prescribed, patients are not receiving the beneficial effects of medication or therapy, leading to poor outcomes and unnecessary complications or costs.

What is non-compliance in healthcare, and what impact does it have on patients and the NHS?

Non-compliance (or “non-adherence”) is used by healthcare professionals to describe a situation in which a patient does not take their prescribed medication or treatment as directed. As healthcare moves away from paternalistic medicine towards person-centred care, “non-compliance” is often regarded as an old-fashioned term, but research shows that for one reason or another many patients are simply not taking their medication or treatments as advised; in fact, only 28% of asthma patients use their inhaler correctly. 

There are several implications that arise from non-compliance that affect both patients and healthcare services. Unnecessary A&E attendances can put strain on doctors and nurses, and result in additional healthcare costs to the NHS. For example, patients with a long-term condition such as asthma that stay overnight in hospital due to deterioration in their condition can cost the NHS over £500 per night. Additionally, patients with prolonged ill-health can spend considerable lengths of time unable to work, causing financial hardship and increased social care costs. The healthcare industry also suffers from lost sales of products and poorer outcomes associated with their products and services.

The majority of non-compliance in the UK and NHS is unintentional and due to a lack of patient understanding. For example, many patients with asthma simply don’t understand how to use an inhaler properly and when to use it, while other patients are unaware that they should be taking cholesterol lowering medication on a long-term basis to manage their health. 

What has been done in the past to minimise non-compliance?

In 2010, Alhalaiqa et al conducted a study investigating the impact of providing patients with face-to-face ‘adherence therapy’ sessions to treat high blood pressure. The study found that there was a significant improvement in compliance with patients’ medication, and an improved blood pressure control when compared to traditional healthcare practice. 

Generally, trials of systems to remind patients to take their medication or follow through with treatments have been ineffective. There are hundreds of apps that provide reminders to patients, but there is little evidence to show these have had a positive effect. 

How can technology and virtual reality make a difference in minimising non-compliance?

When it comes to minimising non-compliance, better forms of communicating information is key. Immersive content, such as virtual reality (VR) and augmented reality (AR), has an advantage over other ways of delivering information. Changing the way patients receive information can lead to vast improvements of patients understanding the need for taking their medication and following instructions correctly. 

Virtual reality (VR) can really have a huge impact. In 2019, a study of HIV patients found that a short VR experience significantly improved their compliance to therapy and improved their clinical markers of disease activity. When compared to text or video, virtual reality engages users for a longer period of time, can lead to better recall of information, and users are more likely to adapt their behaviour. 

VR has been adopted by a range of industries and is gaining traction in healthcare. VR is now being used to successfully train medical students and surgeons with real-life medical simulations. Cognitant uses VR to help patients access medical information via its “Healthinote” platform. With the combined benefits of immersive content and a personalised information platform, patients can better understand their treatments and improve their compliance.