Transcript Professional Communication to Promote Patient Compliance

Communication Strategies
#1 Strategy:
Talk, Care and
Connect
Create A Favorable
Environment
Establish
Privacy
Reduce Physical
Barriers
“Size-Up” the Person’s:
Credibility
 Health
 Knowledge
 Intellect
 Personality
 Emotional Status

Determine Beliefs
Cultural influences
 Beliefs about illness
 Value of illness

Recognize and Adapt to
Person’s Internal “Noise”

High anxiety persons:


Share overall conclusions first
Low anxiety persons

Build toward conclusion
Employ Positive
Non-Verbal Behaviors
Forward lean
 Silence—listen
 Good eye contact
 Warm expression
 Postural synchrony
 Open posture (uncross arms)
 Limit self-adaptors (touching self)

Build a Two-Way
Communication Partnership

Adult-Adult: Empowers Choices
Information
 Insight
 Empathy
 Confidence

Parent-Child: Gives Advice
 Child-Child: Makes Demands

An Adult Approach….

“I’m here to help you get the most
benefit from your medication.”
Avoid “I-It” Relationships
Martin Buber’s Schema…
 I-IT


I- You


Impersonal; doesn’t acknowledge
person
Businesslike, professional or personal
I-Thou

Empathetic with great understanding
There is No Substitute for
Genuine Caring!!
Show real empathy
 Personalize the message

Use the patient’s name
 Engage them in the conversation
 Identify and relate to their needs

Create Credibility



Present a Professional Appearance
Assume a Professional Affect
Establish Trust





Go slow
Follow-through
Display genuine interest
Allow the person to “save face”
Establish Appropriate “Distance” and
“Boundaries”
Introverted Pharmacists
Achieve Greater Compliance

They are perceived as
More trustworthy
 Less overbearing

Helpful
Communication Factors
For Better Adherence Deliver:
 Explicit and appropriate instructions
 More and clearer information
 More and better feedback
Organize the Session





Introduce self and provide a brief
orienting statement
Assess the person’s anxiety and beliefs
Prioritize and structure informationgiving to span 3-5 main points
Employ transitions between ideas
Closing
 Summarize key points
 Provide written information, even to the
most educated patient
Strategies to
Detect Non-Adherence

Gather Objective Data


Interview Person


but not via “an inquisition”
Brown-bag Programs


Refill information and objective lab values
Patients bring all of their medications in a bag
to the pharmacist for counseling
Compliance Clinics
Verbal Strategies
Speak Clearly
 Avoid jargon
 Explain WHY/WHY NOT
 Limit message length



Establish 3-5 key messages
Repeat important content
Probe for Understanding
This is an ethical responsibility
 “The basic and most common cause
of non-compliance is the patient who
does not understand that is
expected.” Frank E. Young MD Ph.D.
Former FDA Commissioner

Strategies to Verify
Understanding

Gentle Probes
“What will you do?” “Show me….”
 “Why?”

Ask the person to review the content
of your counseling
 Ask the person to predict the
medication’s effects

Provide Information-Pt 1





Be persuasive!
Describe use
Inform about side effects
 Research shows: this does not increase
side effects
Tell when and how medication will help
Avoid being too complicated or detailed
Provide Information-Pt 2
Explain benefits of medication
 Raise awareness of body cues
 Explain ways person can selfevaluate therapy
 Help develop coping mechanisms
 Don’t insist that the patient comply

Communicate Via
Multiple Modalities
Speech
 Written materials


be alert to non-readers
Graphics
 Models
 Demos
For best results: employ both oral and
written presentations

Build Message Redundancy
T1 --Explain what you will tell the
patient
 T2 -- Tell it
 T3 -- Review what you told them

Communicate Frequently

Encourage future communication


Suggest calling to discuss concerns
Refill counseling is an important
opportunity to:
Identify changing beliefs about illness
 Identify side effects which may lead to
non-adherence

Enlist Others

Work with MD to:
Simplify regimen
 Reduce number of daily dosage
intervals
 Adjust to person’s daily routine


Enlist family support
Be Creative

Supply medication reminders
Organizers
 Alarms
 Check-off sheets
 Contracts


Remind of refills by mail or
telephone
It’s Not Just About
Information…
The lower the patient satisfaction
with the interaction, the greater the
likelihood of non-adherence
 There is no substitute for a warm
and caring relationship

Therefore, Provide Both…
Accurate Factual Information
 Positive Emotional Aspects

Human Interaction
Increases Adherence
Non-adherence was reduced by 25%
when the pharmacist, rather than
the clerk, handed the medication to
the patient.
 Patient involvement increases
adherence

In closing
We have discussed the differences
between patient compliance, and patient
adherence. The latter is a more complex
and inclusive construct.
We also considered several reasons why
patients do not adhere to treatment
regimens, and how healthcare
professionals can employ effective
communication strategies to increase
patient well-being.