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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.