5 Helping Patients Manage Therapeutic Regimens

Concordance

obligates patients and providers to reach mutual decisions

Empathic Understanding

a core skill in ambivalence and appraoch-avoidance approaches

Mental pictures

any information that patients can mentally picture is more easily remembered.

Compliance

extent to which a person's behavior coincides with the medical advice given.

Adherence

meant to move away from the perception of compliance.

Link new behaviors with habitual behaviors example

take your BP pill at night right after you brush your teeth before going to bed.

Transtheoretical Model of Change

the importance of empathy, self-efficacy, and outcome expectations continue throughout the transition from one stage to another (Precontemplation, Contemplation, Preparation, Action, and Maintenance).

Ambivalence

your patients feel conflicted between wanting to change and wanting to stay the same. Such a conflict is called APPROACH-A VOIDANCE.

Behavioral changes and patient understanding

-Assess literary levels first -Mental pictures -Use first oral information then follow with written information according to literary level -Link new behaviors with habitual behaviors -Call your patients

Do not assume

-Do not assume that physicians have already discussed with patients the medications they prescribe. -Do not assume that patients understand all information provided. -Implementing a new medication regimen requires a change in behavior, which is often difficult. -Do not assume that when patients do not take their medications correctly that they "don't care", "aren't motivated", "lack intelligence", or "can't remember". -Do not assume that once patients start taking their medications correctly, they will continue to take them correctly in the future. -Do not assume that physicians routinely monitor patient medications use and will thus intervene in problems exist. -Do not assume that if patients are having problems, they will ask direct questions or volunteer information.

Dealing with Change

-Motivational Interviewing (Miller & Rollnick, 2002) -Empathic understanding (Rogers, 1951) -Transtheoretical model of change (Prochaska & DiClemente, 19825)

"do not assumes" - open ended questions

-What did your physician tell you about your prescriptions? -Might you be overwhelmed with information? -Great, you understand, so you will be successful -Do you really care? Have you any motivation? Why can't you remember? -So, you are successfully. Can it be sustained? -Who is your first line of defense? -If you have a problem, who do you call?

The "A" word and behavioral change (s)

-What is it about ambivalence? Does it mean your patients are ambivalent to change? -What is approach-avoidance?

Behaviors of medication therapies

1. Compliance 2. Adherence 3. COncordance

6 reasons why patient's don't take their meds (Beardsley, Kimberlin, Tindall 2012)

1. Perception 2. Value 3. Believe 4. Confidence 5. Monetary 6. Relationship

It is important to keep in mind that most persons who are successful in maintaining changes are able to do so in spite of the fact that they made previous attempts that failed. (T/F)

True