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 Communication Decreases 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