1. Communication Strategies #1 Strategy: Talk, Care and Connect

2. Create A Favorable Environment Establish Privacy Reduce Physical Barriers

3. “Size-Up” the Person’s: Credibility Health Knowledge Intellect Personality Emotional Status

4. Determine Beliefs Cultural influences Beliefs about illness Value of illness

5. Recognize and Adapt to Person’s Internal “Noise” High anxiety persons: Share overall conclusions first Low anxiety persons Build toward conclusion

6. Employ Positive Non-Verbal Behaviors Forward lean Silence—listen Good eye contact Warm expression Postural synchrony Open posture (uncross arms) Limit self-adaptors (touching self)

7. Build a Two-Way Communication Partnership Adult-Adult: Empowers Choices Information Insight Empathy Confidence Parent-Child: Gives Advice Child-Child: Makes Demands

8. An Adult Approach…. “I’m here to help you get the most benefit from your medication.”

9. Avoid “I-It” Relationships Martin Buber’s Schema… I-IT Impersonal; doesn’t acknowledge person I- You Businesslike, professional or personal I-Thou Empathetic with great understanding

10. There is No Substitute for Genuine Caring!! Show real empathy Personalize the message Use the patient’s name Engage them in the conversation Identify and relate to their needs

11. Create Credibility Present a Professional Appearance Assume a Professional Affect Establish Trust Go slow Follow-through Display genuine interest Allow the person to “save face” Establish Appropriate “Distance” and “Boundaries”

12. Introverted Pharmacists Achieve Greater Compliance They are perceived as More trustworthy Less overbearing

13. Helpful Communication Factors For Better Adherence Deliver: Explicit and appropriate instructions More and clearer information More and better feedback

14. Organize the Session Introduce self and provide a brief orienting statement Assess the person’s anxiety and beliefs Prioritize and structure information- giving to span 3-5 main points Employ transitions between ideas Closing Summarize key points Provide written information, even to the most educated patient

15. Strategies to Detect Non-Adherence Gather Objective Data Refill information and objective lab values Interview Person but not via “an inquisition” Brown-bag Programs Patients bring all of their medications in a bag to the pharmacist for counseling Compliance Clinics

16. Verbal Strategies Speak Clearly Avoid jargon Explain WHY/WHY NOT Limit message length Establish 3-5 key messages Repeat important content

17. Probe for Understanding This is an ethical responsibility “The basic and most common cause of non-compliance is the patient who does not understand that is expected.”Frank E. Young MD Ph.D. Former FDA Commissioner

18. Strategies to Verify Understanding Gentle Probes “What will you do?” “Show me….” “Why?” Ask the person to review the content of your counseling Ask the person to predict the medication’s effects

19. Provide Information-Pt 1 Be persuasive! Describe use Inform about side effects Research shows: this does not increase side effects Tell when and how medication will help Avoid being too complicated or detailed

20. Provide Information-Pt 2 Explain benefits of medication Raise awareness of body cues Explain ways person can self- evaluate therapy Help develop coping mechanisms Don’t insist that the patient comply

21. Communicate Via Multiple Modalities Speech Written materials be alert to non-readers Graphics Models Demos For best results: employ both oral and written presentations

22. Build Message Redundancy T1 --Explain what you will tell the patient T2-- Tell it T3 -- Review what you told them

23. Communicate Frequently Encourage future communication Suggest calling to discuss concerns Refill counseling is an important opportunity to: Identify changing beliefs about illness Identify side effects which may lead to non-adherence

24. Enlist Others Work with MD to: Simplify regimen Reduce number of daily dosage intervals Adjust to person’s daily routine Enlist family support

25. Be Creative Supply medication reminders Organizers Alarms Check-off sheets Contracts Remind of refills by mail or telephone

26. It’s Not Just About Information… The lower the patient satisfaction with the interaction, the greater the likelihood of non-adherence There is no substitute for a warm and caring relationship

27. Therefore, Provide Both… Accurate Factual Information Positive Emotional Aspects

28. Human Interaction Increases Adherence Non-adherence was reduced by 25% when the pharmacist, rather than the clerk, handed the medication to the patient. Patient involvement increases adherence

29. In closing We have discussed the differences between patient compliance, and patient adherence. The latter is a more complex and inclusive construct. We also considered several reasons why patients do not adhere to treatment regimens, and how healthcare professionals can employ effective communication strategies to increase patient well-being.