MJ

Helping Patients Manage Therapeutic Regimens

False Assumptions about Patient Understanding Techniques to Improve Patient Understanding

  • Do not assume
    • “Common sense” is no longer common

Seven false assumptions pharmacists often make:

  1. Do not assume that physicians or other providers have already discussed

    the medications they prescribe to patients

  2. Information provided

    1. Some people make understand it as only waking hours, so, if it is every 6 hours they are only taking their medications twice a day instead of 4 times
    2. Make sure they know not to double up a dose if one happens to get missed

  3. Do not assume that if patients understand what is required, they will be able

    to take the medication correctly.

  4. Do not assume that when patients do not take their medications correctly that

    they "don't care," "aren't motivated," "lack intelligence," or "can't remember."

  5. Do not assume that once patients start taking their medications correctly, they

    will continue to take them correctly in the future.

    1. Sometimes if the patient feels better after taking their medications properly, they suddenly stop since they feel better again

  6. Refrain from assuming other providers routinely monitor patient medication use and will thus intervene if problems exist.

  7. Do not assume that if patients are having problems, they will ask direct questions or volunteer information.

    1. Some have a more challenging time opening up
    2. Others are embarrassed

Techniques to Establish New Behaviors and Medication Adherence

Now you know what not to assume, how do you make sure the patients have the right information?

  1. Emphasize key Points: tell them they need to remember what you will say next.

  2. Give Reasons for Key advice: are more prone to listen if they understand

  3. Give, define, concrete, explicit instructions: use more than one learning method

    1. Show pictures, and videos, make it hands-on
    2. It is easier to grasp if something is simplified and specific

  4. Provide key information at the beginning and the end: they are trying to grasp everything you are saying at once, going them the highlights at the end, so it is the last thing in their minds when they leave

  5. End the encounter by asking for feedback

    1. So you know they know what was said
    2. Shows you what you need to work on as well
  • Combine both oral and written information
    • So when the patients go home, they have a point of reference when they have to go through it on their own
  • Never assume the patient understands. ALWAYS clarify

Techniques to Facilitate Behavior Change

  1. Help patients identify ways to integrate new behaviors with current habits

    1. It is the little things like at first setting alarms when to take your medications until it becomes routine
    2. Try post-its
    3. Have them in view

  2. Provide appropriate adherence aids

    1. Some use blister packs some add them to their daily schedules

  3. Suggest Ways Self-Monitor

    1. Have a medication diary

  4. Monitor Medication Use

    1. Take note of things like late refills

  5. Make Proper Referrals

    1. Make sure they have the materials to succeed

Techniques to Facilitate Behavior Change

  • Behaviour change is hard
  • Many patients struggle with it
  • It shows many mixed emotions

Theoretical Foundations Supporting Behavior Change

  • Motivational Intervention: to help make changes in the direction of health
  • Three things to strengthen motivation
    • Willingness
    • Self-efficacy/ self-confidence.'
    • Readiness
  • Motivational interviewing adds techniques connected with the social cognitive framework
    • They do it thinking it is possible
    • Succeed, knowing it is possible, and continues
  • The patient needs to believe in the product or the action in order for them to either become efficient or to create a good habit.
  • Stages of conceptualization
    • Recompilation: have no intention of changing
    • Obvious to the risks
    • Try to raise awareness and encourage them to think it over.
    • Contemplation: are you debating it
    • Aware of the risks
    • Might be willing to change
    • Continue to encourage them
    • Show empathy
    • Preparation: they see the benefits
    • Willing to change
    • Encourage small steps
    • Action: face challenges
    • Change as begun
    • Help them plan how to overcome barriers
    • Help them overcome barriers
    • Maintenance: they are >6 months in
    • Change is a new habit
    • Encourage them to keep going
    • Help them problem solve

Applying Motivational Interviewing Principles and Strategies

  • Express Empathy: show you understand where they are coming from
    • Show absolutely no judgment
    • Don’t pressure them
  • Develop Discrepancy: let patients present arguments in favor of change.
  • Roll with Resistance: accept that the patients may say no and that they have the final say.
    • Do not get heated at the moment
    • It is not helpful if they get defensive
  • Support Self-Efficacy: given them options
    • Help the patients draw the right conclusions
  • Elicit and Reinforce “Change Talk”: encourage them to take action
  • Build their confidence
  • Implement the “Relapse Prevention” Program
    • Why people relapse
    • Emotional distress, particularly anxiety, depression, worry, boredom, and conflict
    • Social pressure
    • Guilt and self-blame for lapses or one-time slips
    • Overconfidence
    • Frequent temptation
    • The desire for immediate gratification, thinking if it is not working now it never will
    • How to prevent relapse
    • Differentiate a “slip” and a “relapse”
      • One being more permanent than the other and how to to back on track
    • No surprises coaching them in different scenarios and not succumbing to temptation
    • Do not let them be hard on themselves
      • Life happens, so do whatever you can to get back on track