Patient Compliance Saudi Diploma in Family Medicine Center

Patient Compliance Saudi Diploma in Family Medicine Center of Post Graduate Studies in Family Medicine Presented by: Dr. Zekeriya Aktürk zekeriya. akturk@gmail. com www. aile. net 1 / 29

Communication to Promote Therapeutic Adherence Ellen R. Cohn Ph. D University of Pittsburgh ecohn+@pitt. edu 2 / 29

Ellen Cohn Ph. D 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 pharmacybased communication. ecohn@pitt. edu 3 / 29

First, A Quiz… • 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. 4 / 29

…the Answers • 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. 5 / 29

Purpose and Audience The purpose of this presentation is to: • Enhance the reader’s understanding of nonadherence, 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 6 / 29

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 7 / 29

Compliance: A More Recent Definition • “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 8 / 29

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 9 / 29

Adherence— It’s A Complex Construct! Includes: • The Person (patient) • The Medication • Spouse/Family/Peers • The Person-Healthcare Professional Relationship 10 / 29

Adherence: Suggests A “Person Centered” Approach • 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 11 / 29

Adherence Is Not Consistently Related To: • • Social class Age Gender Education Marital status Intelligence Memory Personality disorders 12 / 29

Next…. We will consider five possible contributors to non-adherence: • Patient testing • Health beliefs • Poor communication • Cognitive factors 13 / 29

Causes of Non-Adherence: Patient Testing • Patients weigh costs vs. benefits of Rx – Address these before non-adherence occurs • Ask the person: do you think there will be any problems with the medication? – Provide information – Provide strategies 14 / 29

Causes of Non-Adherence: Health Beliefs • Person’s perceptions of – Seriousness of illness – Outcomes of non-treatment • • • Perceived ineffectiveness of tx Lack of social support Social discouragement Adverse effects Lengthy/complicated tx 15 / 29

Causes of Non-Adherence: Cognitive Factors • Forgetfulness • Anxiety 16 / 29

Causes of Non-Adherence: Poor Communication • • Minimal medical supervision Insufficient instruction Poor feedback Interactions with health professional – Perceived as unfriendly – Perceived as unconcerned – Little interaction – Unilateral interaction 17 / 29

Unethical Communication Decreases Adherence • Ethical communication empowers persons to make informed choices – The cruelest lies are often told in silence. ” Robert Lewis Stevenson 18 / 29

Ethical Communication • 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 19 / 29