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Communication to Promote Therapeutic Adherence

Communication to Promote Therapeutic Adherence. Ellen R. Cohn PhD University of Pittsburgh ecohn+@pitt.edu.

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Communication to Promote Therapeutic Adherence

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  1. Communication to Promote Therapeutic Adherence Ellen R. Cohn PhD University of Pittsburgh ecohn+@pitt.edu

  2. 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. ecohn@pitt.edu

  3. 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. …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. 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

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

  10. 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. Adherence Is Not Consistently Related To: • Social class • Age • Gender • Education • Marital status • Intelligence • Memory • Personality disorders

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

  13. 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. 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. Causes of Non-Adherence:Cognitive Factors • Forgetfulness • Anxiety

  16. 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. Unethical CommunicationDecreases Adherence • Ethical communication empowers persons to make informed choices • The cruelest lies are often told in silence.” Robert Lewis Stevenson

  18. 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

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