Transcript Professional Communication to Promote Patient Compliance

Communication to Promote
Therapeutic Adherence
Ellen R. Cohn PhD
University of Pittsburgh
[email protected]
Ellen Cohn PhD is Director
of Instructional
Development at the
University of Pittsburgh
School of Health and
Rehabilitation Sciences.
She also has a secondary
appointment in the School
of Pharmacy, where she
teaches healthcare and
pharmacy-based
communication.
[email protected]
First, A Quiz…
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T-F Better educated patients are more
compliant.
T-F Patients of introverted (vs.
extroverted) pharmacists show more
compliance.
T-F Telling a patient about potential side
effects increases the likelihood they will
occur.
T-F Pharmacist-patient interaction
increases compliance.
…the Answers
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True- Better educated patients are more
compliant.
True- Patients of introverted (vs.
extroverted) pharmacists show more
compliance.
False-Telling a patient about potential side
effects increases the likelihood they will
occur.
True- Pharmacist-patient interaction
increases compliance.
Purpose and Audience
The purpose of this presentation is to:
 Enhance the reader’s understanding of
non-adherence, and
 Present communication strategies to
promote patients’ compliance to
therapeutic regimens.
While the lecture was written for pharmacy
students, the content may also be useful
for other healthcare providers
Non-Compliance:
An Ancient View
“Keep watch also on the fault of
patients which often makes them lie
about taking things prescribed.”
Hippocrates
 The patient must be monitored by
their doctor
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Compliance:
A More Recent Definition
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“The extent to which a person’s
behavior (in terms of taking
medications, following diets, or
executing life style changes”)
coincides with medical or health
advice.” Sackett and Snow, 1979
Compliance:
It’s A Medical Construct
The patient must follow the
physician’s orders
 This construct implies it’s always
wise to follow the health care
provider’s advice
 A more recent approach is to
consider patient behavior in terms of
adherence
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Adherence—
It’s A Complex Construct!
Includes:
 The Person (patient)
 The Medication
 Spouse/Family/Peers
 The Person-Healthcare Professional
Relationship
Adherence: Suggests A
“Person Centered” Approach
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Encourages self-regulation
Recognizes that non-adherence is
sometimes logical and warranted
Person joins with the pharmacist to get
the most benefit from the medication
The professional has “unconditional
positive regard” for the patient
There is mutual trust and respect
Adherence Is Not
Consistently Related To:
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Social class
Age
Gender
Education
Marital status
Intelligence
Memory
Personality disorders
Next….
We will consider five possible
contributors to non-adherence:
 Patient testing
 Health beliefs
 Poor communication
 Cognitive factors
Causes of Non-Adherence:
Patient Testing
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Patients weigh costs vs. benefits of
Rx
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Address these before non-adherence
occurs
Ask the person: do you think there
will be any problems with the
medication?
Provide information
 Provide strategies
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Causes of Non-Adherence:
Health Beliefs
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Person’s perceptions of
Seriousness of illness
 Outcomes of non-treatment
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Perceived ineffectiveness of tx
 Lack of social support
 Social discouragement
 Adverse effects
 Lengthy/complicated tx
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Causes of Non-Adherence:
Cognitive Factors
Forgetfulness
 Anxiety
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Causes of Non-Adherence:
Poor Communication
Minimal medical supervision
 Insufficient instruction
 Poor feedback
 Interactions with health professional
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Perceived as unfriendly
 Perceived as unconcerned
 Little interaction
 Unilateral interaction
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Unethical Communication
Decreases Adherence
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Ethical communication empowers
persons to make informed choices
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The cruelest lies are often told in
silence.” Robert Lewis Stevenson
Ethical Communication
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Helps person recognize their situation
Helps person become aware of resources
and their relevance
Helps person achieve motivation and
reduce anxiety
Promotes a warm, caring environment
within a professional relationship