By Christine Foss MD, DC, MS. ED., ATC, DACBSP, DACRB, ICSC
Patient compliance is critical to achieve successful outcomes in chiropractic care. Despite the proven benefits and positive patient outcomes with the use of chiropractic treatments for conditions such as back pain, neck pain, and headaches, a patient’s ability to comply with a treatment plan can sometimes be challenging.
Because chiropractic care requires patients to come to the office to see the doctor at a prescribed cadence, compliance is the secret to success. Improving patient compliance enhances individual health outcomes and contributes to chiropractic practices’ overall success and reputation. We can develop several strategies in our offices to enable better patient compliance.
To establish good patient compliance, we must first understand what compliance means to the office and the patient. A pure definition of compliance is the patient’s ability or desire to adhere to a care or treatment plan as prescribed by a healthcare practitioner. In chiropractic care, this may include attending scheduled appointments, performing prescribed exercises, and making lifestyle adjustments.
Noncompliance can lead to suboptimal treatment outcomes, prolonged recovery times, and increased healthcare costs. The doctor and the patient need to understand this fact at the onset of treatment.
Several factors influence patient compliance in chiropractic care, including:
Patient Understanding and Education: Patients who understand their condition and the rationale behind their treatment plan are more likely to adhere to it. This is one of the most important aspects of compliance.
Communication and Trust: Effective communication and a strong patient-provider relationship are crucial for fostering compliance. Practitioners need to develop a decisive message for their care plan and deliver it in a manner that the patient understands.
Convenience and Accessibility: Factors such as clinic location, appointment availability, and transportation can affect a patient’s ability to comply with treatment. Key factors are making office visits easy to schedule and scheduling them at times that work for the patient.
Perceived Efficacy: Patients are more likely to follow through with treatment if they believe it will be effective, which is where good patient education circles back to patient communication. The patient must feel the value of each visit to the office.
Personal and Cultural Beliefs: Individual beliefs about health and wellness and cultural attitudes toward chiropractic care can influence compliance. Practitioners need to understand diverse cultural nuances in the acceptance and type of health care that is socially acceptable. This also applies to the gender of the treating doctor and patient in some cultures. Being sensitive and accommodating to these factors is important to allow the patient to comply with care.
Clear Explanations: Provide clear and concise explanations about the patient’s condition, the proposed treatment plan, and the expected outcomes. Use visual aids and models to enhance understanding. Appeal to the visual, auditory, and kinesthetic patients’ style of learning as you explain the proposed plan of care.
Educational Materials: Offer educational materials, such as brochures, videos, and handouts, that patients can review at home. These materials should reinforce the information discussed during appointments. Patients often hear a small amount of what you say and then shut down. A written or printed plan of care will allow the patient to digest the information after the visit. So often, we take the time to buy fancy treatment tools, but if the patient does not return to the office, those modalities are useless.
One idea is to use a quality report of findings tool, such as a posture scan with a computerized printout. This concept offers a tool for the doctor to give a visual, auditory, and kinesthetic report of findings that the patient can learn from, which is money well spent on patient compliance.
Active Listening: Take the time to listen to patients’ concerns, questions, and preferences to help build trust and rapport. So often, patients will communicate about the doctor’s ability to listen, take time, and understand their perspective of the compliance in question.
Empathy and Support: Show empathy and provide emotional support. A compassionate approach can make patients feel more comfortable and valued. Again, the term “bedside manner” is an important concept to make a patient feel that it is worth your time and their time for them to come to the office.
Personalized Care: Tailor treatment plans to meet the unique needs and goals of each patient. Personalization can increase patient engagement and adherence. As we know, patients have vastly different responses to care, exercise progressions, and motivations. Making the patient feel that you just are not giving them some photocopied sheet that you provide all patients for home exercise is a win. Take the time to tailor each care plan to the patient in front of you.
For example, use a product, such as a custom-made flexible orthotic, that is individually made for the patient with their goals, activity level, and interests in mind. Patients appreciate bringing in ancillary options to enhance care.
Flexible Scheduling: Offer flexible scheduling options, including evening and weekend appointments, to accommodate patients’ busy lives. A website that allows a patient to schedule easily is a straightforward way to improve in this aspect.
Transportation Assistance: Provide information about transportation options or offer help for patients who may have difficulty getting to appointments. This is a challenge for many offices, but one thought is to provide a pick-up service for patients to get to the office.
Location and Facilities: Ensure that the clinic is easily accessible and has comfortable, welcoming facilities. Your front desk provides the first and last impressions. Make it welcoming and friendly, and ensure that your facility is clean and well kept.
Goal Setting: Set realistic and achievable goals with patients. Celebrate milestones and progress to keep them motivated. Goal setting is also important among the staff, and morning staff meetings help get everyone on the same page. Monthly staff lunches to discuss issues or changes in protocols are a fantastic way to bring the staff together and make them feel heard.
Positive Reinforcement: Provide positive reinforcement and encouragement. Celebrate patient milestones and forward motion in care. It is important that the patient feels progress. Follow-up evaluations and reports of findings on improvements are critical for continued patient compliance.
Behavioral Contracts: Consider using behavioral contracts that outline the patient’s responsibilities and expected outcomes. It is an innovative and effective idea that can create a sense of commitment and accountability. Have the patient join your team to help them get better.
Identity Barriers: Often, patients will tell you why they cannot come in for care, afford care, or do the home exercise. These barriers need to be explored and broken for the patient to progress in care. Understand how to pivot and bend to accommodate the restraints when possible.
Problem-solving: Collaborate with patients to develop practical solutions to overcome these barriers. This may include offering payment plans, adjusting treatment frequency, or providing reassurance and education.
Regular Follow-Up: Schedule regular follow-up appointments to monitor progress and address any concerns or issues that may arise. Set a date during the initial visit for a follow-up evaluation, e.g., at the two- or three-week mark. At that point in care, the patient should notice forward motion in care, and if not, the plan needs to be adjusted.
Progress Tracking: Use tools such as progress charts and patient diaries to track adherence and outcomes. Sharing this information with patients can reinforce the importance of compliance. There are so many great tools for initial and follow-up tracking. This often falls by the wayside, and this necessary component reengages the patient to continue care.
Improving patient compliance in chiropractic care requires a multifaceted approach that addresses the many factors influencing adherence. As discussed in this article, addressing things such as communication, patient education, motivation, and exploring barriers to success will enhance patient compliance in the office.
Additionally, it is important to conduct a comprehensive exam and report findings using tools such as a posture scan that includes the foot, upper back, and neck. This type of scan can give the patient a concise printout of the findings and plan of care while being time-efficient for the practitioner in the office.
A compliant patient is a patient who will get better. An office that enables patient compliance to heal and functionally improve holds the key to patient and office success.
Dr. Christine Foss is the director of the certified chiropractic sports physician program for Northeast Chiropractic College. She was named the 2020 American Chiropractic Association Sports Council Chiropractor of the Year and was the 2023 International Federation of Sports Chiropractic Educator of the Year. Dr. Foss currently serves as the director of education at Foot Levelers.
