Download Patient compliance DOC - PBL-J-2015

CD Week 22: Patient compliance
“An action in obedience to another request”
COMPLIANCE IS A MAJOR HEALTH PROBLEM!
What is non-compliance?
 Failure to take recommended dose and at recommended times, failure to
complete course of treatment, taking drugs for wrong person, taking other
medications that are otherwise contraindicated
 Studies show about 1/3 to ½ patients are non-compliant in one way or
another!
Discussion prompt:
Consider reasons why patients may not comply, and appropriate strategies the
doctor may use to improve compliance (or adherence). Consider potential
divergence between the doctor’s desired outcomes, and the patient’s.
Identify factors influencing compliance and non-compliance.
1. Patient characteristics (Age, Gender, Race, Personality, attitude to illness,
doctor or their life, socioeconomic status, ability to communicate and
comprehend/understand) social supervision, preference for complementary
medicine)
2. Treatment Setting (Inpatients vs. our patients)
80% supervised compared <50% with minimal supervision/follow-up
3. Medication characteristics (Amount of total medications, similar appearance of
medication, number of doses per day, taste of medication, side effects caused)
4. Clinical features of the illness (Chronic illness, mild/asymptomatic illness, delay
in consequence of stopping treatment)
5. Clinician expertise (Ability of prescriber, relationship with patient, confidence in
treatment, information to patient).
Identify strategies to increase compliance.
First is to identify “at risk” patients
Some of these include:
 Chronic illness
 Long term treatment
 Prevention treatment
 Elderly & children
 Hostile patients
 Multiple medications
 Frequent dosing
Now need to plan an appropriate treatment regime which MUST provide suitable
explanation. Vital to complement verbal information with written. Verbal has 10%
recall, visual 20% recall and combined that show up to 65% recall after 3 days!
What needs to be explained?
 nature of illness
 goal of treatment
 target symptoms
 disclose likely side effects
 reassure
 establish therapeutic alliance
 positive approach
 engender hope
REMEMBER!!! Only prescribe drugs that are needed and try use medications that
can be given once daily, continually review medication and progress of patient, try
match a simple regime to daily routines, try to involve family/friends and stress
necessity of compliance always!!
Consider the potential impact on the therapeutic relationship when a
patient is non-compliant with recommendations.
 Poor/futile treatment outcome could threaten relationship
 Frustration (both patient and doctor)
 Loss of trust and confidence
Discuss the issues for doctors when patients are non-compliant with
treatment and / or poor self-management resulting in poorly controlled
disease and increased complications.
Discussion prompts:
How would you feel if the patient didn’t follow your advice & allowed their disease?
to get out of control, so suffering serious health complications?
Is it ethical to frighten a patient into complying with medical care or advice?
Ethical principles in patient care
Discussion prompt:
This is an opportunity to reflect on the issue of how the way you feel about
someone or something can affect how you provide medical care. Get students to
consider experiences in clinical attachments. Do you really look after everyone the
same, or are there patients that you will do more for? Is that reasonable? Yes if you
recognise what you are doing, but beware the seductive needy patient.
Reading: Ethical principles in patient care - impartiality, commitment, continuity and
non-abandonment
 Impartiality
Doctors must not be swayed by demands of others such as relatives, insurers,
administrators or compromise patient care for other reasons (such as financial gain).
 Commitment & continuity
Grows with training and experience and straightforward in most cases. But the
difficult cases that is much harder and show undesired outcome that test the Doctor.
Doctor may need to sacrifice a lot of their ‘self’ in order to meet the best interests of
the patient in need
After a major medical incident that has left a patient with serious complications, It is
not an ethical or a legal defence to claim that the doctor was unable to be there
because they were too tired, had plane to catch or had a long day. This is the reality
and demands of being a doctor. Can’t claim responsibility on ‘team work’ as despite
teamwork being vital-the key player is the doctor! They’ve often been used to avoid
responsibility
 Non-abandonment
Doctors should never abandon their patients - whether those patients are terminally
and incurably ill. Even if no treatment they can offer!
Whether to assist in palliation or giving of yourself as a human being-even if it means
just sitting at the bedside, talking with them and uphold their human dignity!
Doctor who leave destroy that patients trust and morale and or will the family forget
that abandonment-leaves them hurt and tarnishing doctors’ reputation.