Regarding Alma I would first plan my approach to make her feel important in her care and respected. I would make eye contact, smile, introduce myself and clearly explain to the patient all my actions before doing them to attempt to build a rapport. I would assess the patient’s beliefs, daily activities, current behaviors, treatments and environment. All keeping in mind that this patient may take time to accept me as someone she wants to trust. Issues and experiences are going to be very important to analyze to get to underlying reasons the patient acted like this. I also would make sure to assess patient understanding of medical history, and current medicatons. I would speak clearly, slowly, and in normal tone repeating as necessary to the patient as needed. However, I would aim for patient centered care and involvement, since the reading says the patients that are complaint are just following instruction rather than making a choice I would much rather follow strategies that empower the patient to be active in health care. Collaboration is between the patient, physician, nurses, pharmacist, dietician and any other provider that is part of the care team. Effective communication and collaboration between health professional and patient, guided by factual information and experience of the health professional, allows patients to make informed choices about an agreed upon recommendation (Falvo, 2011). Outcomes are more favorable when patient centered care and collaboration are applied.
Research suggests strategies that can be rememebered by the pneumonic “SIMPLE”
S= Simplifying regimen characteristics such as adjusting medications (time, dosage, frequency), matching the patient with activities of daily living, using reminders of changes in routine (medication reminders, excercise ot routine reminders, medication boxes with daily routine planned out)
Imparting knowledge= distributing written pamphlets, or handouts. Discussing with care team (nurse, physician, pharmacist). Analyzing patient knowledge and
M= Modifying patient beliefs- Assessing perceived susceptibility, severity, benefit, and barriers. Rewarding, tailoring, and contingency contracting
P= Patient and family- providing patient with clear messages and active listening. Including the patient in decisions regarding care. Sending reminders or follow up via email, phone, call or mail.
L= Leave the bias- Tailoring the education to patients’ level of understanding
E-Evaluate adherence- Patient self reporting is most common. Pill counting or logging of activities.
“Clinicians can optimize behavior change by ensuring that the patients (1) perceive themselves to be at risk due to lack of adoption of healthy behavior (perceived susceptibility), (2) perceive their medical conditions to be serious (perceived severity), (3) believe in the positive effects of the suggested treatment (perceived benefits), (4) have channels to address their fears and concerns (perceived barriers), and (5) perceive themselves as having the requisite skills to perform the healthy behavior (Atrja, Bellam, &Levy, 2005).”
Reference:
Atreja, A., Bellam, N., & Levy, S. R. (2005). Strategies to enhance patient adherence: making it simple. MedGenMed : Medscape general medicine, 7(1), 4.
Falvo, D. (2011). Effective Patient Education: A Guide to Increased Adherence. Retrieved from https://www.gcumedia.com/digital-resources/jones-and-bartlett/2010/effective-patient-education_a-guide-to-increased-adherence_ebook_4e.php
REPLY2
There are many different efforts that could be taken in order to use collaboration to assist in compliance with a patient as difficult as Alma.The first effort could be integrating the family member, significant other or caretaker in with the patient education and treatment plan.This would give Alma someone that she trusts involvement in her care, which would be supplemental support in ensuring Alma remained compliant in her care, especially post-procedurally when Alma will need to follow after care instructions to avoid complications.Another source of collaboration is a multi-disciplinary approach.This type of care would require the collaboration and coordination among healthcare professionals involved in Alma’s care such as the general practitioner, pharmacists, health insurers and other practitioners involved in her care.Not only would all of her healthcare providers be aligned in her care, it alleviates some risk of polypharmacy and any conflict of interests between providers.Having a health insurer involved in the collaboration can reduce dispersion in care that could result in higher costs, which would ultimately decrease the cost strain on the patient.Finally, it would be of most importance to ensure Alma was part of the collaboration so that she felt empowered in her decision-making and was an active participant in her treatment plan.Combining all factors of this collaboration would help ensure that Alma was compliant in her procedure and post-procedural medications.
References:
Costa, E., Giardini, A., Savin, M., Menditto, E., Lehane, E., Laosa, O., . . . Marengoni, A. (2015, September 14). Interventional tools to improve medication adherence: Review of literature. Retrieved October 06, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4576894/
