Our group chose the topic of Patient Compliance. "What is patient compliance?", you may ask. Patient compliance is the act of a patient following through with the directions that their care-giver has given them. This topic relates to health communication in a few ways.
Patient compliance relates to health communications because it focuses on the doctor patient relationship. Patient Compliance describes the amount to which a patient correctly follows medical advice. In recent research it comes to show that many patients fail to comply with the medication instruction for a number of reasons, for example health communication. Patient compliance relates to health communication because after communicating there is a response that occurs. After speaking with a doctor about an illness, the doctor usually suggests medicine, or any steps to take next. Unfortunately, some people don't like to take directions from others, or think they know best. They may end up completely skipping all of the medication, hence worsening their condition. It's important to have a good relationship with your patient- one that insures they will follow through with whatever it takes to help them feel better.
This is an important issue because by listening to the patients attitude, beliefs and feelings toward medical treatment, it can draw an agreement on a treatment plan that works best for the patient. With better health communication a patient can develop a better physician-patient relationship that will influence patients to follow and comply with the doctors' advice such as taking medication regularly, returning to a follow-up appointment, and making lifestyle changes. Most of what we have been focusing on thus far has been about patient-caregiver interaction, but we haven't discussed what goes on as soon as the patient leaves the office. It's one thing to have a nice relationship inside the office, but it's strange when patients refuse to take the advice they have given. This makes us think they are resentful in some way or think they know best. This opens up a whole new area of study.
Research on patient-caregiver information has been done, and a few things have been found. There is a term known as blocking, which is a process by which caregivers steer away from certain subjects (du Pre, 51). Due to this, nurses or doctors have been observed to ignore complaints or avoid patients' emotional declarations. Instances like this are what create the patient-caregiver gap and deteriorate the patience compliance component. If a patient feels misunderstood, misinformed, and unappreciated, they will likely naturally refute any suggestions or medications that the doctor suggested.
Doctors have also been found to patronize their patients. This means that doctors treat patients as if they are below them. Speaking down on them, withholding information, and ignoring their feelings are all things that can occur. There is an example of this occurring, in which the doctor should have listened to his patient, as it would have saved the mishap. A women had previously been diagnosed with a hormone deficiency which had caused her one miscarriage. The women petitioned that her new doctor begin hormone replacement therapy at the beginning of her new pregnancy, but he did not oblige. He thought he knew better. A few weeks later, the woman went through another miscarriage. Instances like this continue to illustrate that when patients begin to realize that their doctors may not have their best interest in mind, or simply will do only what they think is best, the patient will be less likely to comply with them the next time they suggest something.
Much research has been dedicated to identifying how to enhance patient compliance. The patient and Physician involvement can be the start to improving patient compliance by using the health decision model that will help “modify general and specific health beliefs, modifying therapeutic recommendations to reflect patients preferences, modifying
There has been much research suggesting that a patient’s beliefs make a significant contribution to deciding whether to comply with treatment plans. The health decision model above gives us an insight on how the patient mind functions before making a health decision. The Health decision model incorporates major strengths of the health belief model and combines decision analysis, and the behavioral decision theory to represent the way in which information is presented to the patient.
Some of the reasons for which a patient may not comply to treatment regimen may be due to the following.
· -There has been an increasing awareness that physicians can be sometimes wrong, which will cause patients in -occasion to ignore instructions from physician and lean on there own understanding.
· -Past experience with personal compliance, witnessed or heard about.
· - People are continuously exposed to controversies, contradictions and reversal to medical recommendation.
· - Preference shifts when outcomes are framed in the terms of the probability of living or dying.
· -Behavioral biases, health beliefs, misinterpretation of factual information, parents beliefs, cultural standards, and acceptance to information given by non-medical sources
· - Regimen complexity or inconvenience.
· -Patients don’t have knowledge or understand treatment.
· -Social interaction.
· -How much patient-physician involvement.
During our research, one of our group members, Enida Selimovic, found a great article that dealt with patient compliance. The article is titled "Beyond Community Treatment Orders" and was written in the International Journal of Mental Health Vol. 41, Issue 4, Pg. 62-81. She read through the article and highlighted a lot of the main points, as well as providing personal feedback. We as a group got a lot from her abstract, so we'd like to share it.
Description: This article is about the effectiveness of a community- based treatment program which is to improve the patient compliance of those that are seriously mentally ill. This article puts the program to a test to see it the community program in fact works. They look at a couple of different countries that use this program like Canada. Advanced directives are also studied here to see the correlation between this. Intensive case management and recovery-oriented service system reform is also looked at in this study. This article looks at one of the biggest health issues in our society today, mental illness, a disease that affects those that have the disease, their families and their communities. This is a good article that relates to our project because mental illness is something that has been uprising and at least 20 percent of our population will experience some type of degree of mental illness in their lifetime. This has been an issue because the patients themselves and their families have not been introduced to the disease before and it is new for them, which means that they do not know how to handle it and how to deal with themselves or their loved ones. It is important to look at issues like this because we need to be able to understand one another and the disease, making it easier for us to talk to one another about this and to our health providers in order to get the right help that we need.
Purpose: The study was about CTOs, community treatment orders, in communities in the United States and Canada. This started because they wanted to identify the right, “more humane and less restrictive way” in how to take care of those that are mentally ill. “The purpose of a community treatment order is to provide a person who suffers from a serious mental disorder, with a comprehensive plan of community- based treatment or care and supervision that is less restrictive than being detained in a psychiatric facility.” By doing this study, it allowed them to learn more about the people and how to correctly provide care and how what they do affects them in which way.
Theoretic Rationale: The author looks at other studies that have been done in the past with CTOs. They looked at what the conditions were in the areas that the CTOs were introduced in. For example they looked at New Zealand and how they introduced CTOs along with the Mental Health Act in 1992. After New Zealand, they followed different countries throughout time and their action with CTOs and how each aspect of it was changed through the years.
Hypotheses or Research Question: The authors researched CTOs in different parts of the communities in different parts of the world and tried to compare and contrast what the effects on the individuals, family and the community as a whole, the CTOs had on them.
Participants: The Participants were people in these communities of different cities in different countries that fit the conditions of which they wanted. The participants were individual with a mental disorder or family members of individuals with a mental disorder. They also used data from the previous years to gather conclusions on what they thought would happen, and used this data to predict come statistics for future residents of these communities. The study involved 250 individual and 1,000 group interviews.
Results/ Findings: They found that the impact of the CTOs was positive, however they needed to do further research to explore for more ways in which it will help them help the individuals with severe mental illnesses.
Discussion: Other than summarizing the results, the authors also provide alternatives to CTOs and discusses what these are and how they affect us. These include Advance Directives and Intensive Case management. They also list problems with their study and what went right and what did not. They also do list that the need to do more research in order to come to more conclusions which will help them with these individuals that need more help.
Critique: I think this was a good study because it listed all of the steps in a language that was simple enough to understand and allowed for me to know everything that they were talking about and how it related to both myself and the project that I am doing. It had a lot of strength in areas where it had data from all different places and had a lot of variety. I believe this study is important because it allows for us to understand how those with mental disorders that are more severe, deal with their health care providers and how they accept or don't accept the treatment that is offered to them.
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Apart from doing formal research, we also held interviews with people, as well as an online survey. We each interviewed one person with a single question-- we will review those first.
Angelicas' question to her mother was "Do you feel as though your doctor be-littles you? If so, does this affect how compliant you will be?" Her mothers answer was- "No, I don't feel like my doctor be-littles me. She may act quick at times, but she doesn't act as though I am any less educated than her. If I don't know about something, she is willing to explain it to me in greater detail. As for the compliance part of the question, I think that if my doctor was in fact rude and treated me like I was foolish, I would probably be less likely to take her advice. I would also seek a different doctor because I don't want a doctors attitude to prevent me from healing."
Enidas' question to a co-worker was "How do you feel about taking orders from a doctor?" The response was "I'm okay with it because I trust the doctor to know what's best for me."
-As we can see, the second interview answer was opposite of the first. In the first interview question, the interviewee said that she would not take orders from her doctor if she was treated poorly. In this second instance we see that the co-worker holds doctors on a high pedestal. They believe that the doctor is all knowing and therefor they should comply.-
Ruths' question to a classmate was "Have you ever been prescribed a medicine that you decided not to take? If so, why?". Her classmates answer was "Yes, that has happened to me before. It wasn't really anything against the doctor, It was more about me. I was scared of all the side-effects and figured It wouldn't make much of a difference if I decided not to take the prescription."
Monica's question to her mother was: "Woud you say that you trust everything your doctor tells you, in terms of advise they give about medication or suggestions for your health?"
Her mothers answer was, "Yes, I would say that I fully trust my doctor and all of the health advice that I am given. I have had the same doctor for many years now and I am very happy with our current patient doctor relationship. I have no hesitations when it comes to asking my doctor a question or showing my concern about certain suggestions he gives to me. I feel that it is very important to be comfortable enough to share your questions or concerns with your doctor any time that you have them."
Monica's question to her mother was: "Woud you say that you trust everything your doctor tells you, in terms of advise they give about medication or suggestions for your health?"
Her mothers answer was, "Yes, I would say that I fully trust my doctor and all of the health advice that I am given. I have had the same doctor for many years now and I am very happy with our current patient doctor relationship. I have no hesitations when it comes to asking my doctor a question or showing my concern about certain suggestions he gives to me. I feel that it is very important to be comfortable enough to share your questions or concerns with your doctor any time that you have them."
As for the online survey-- we included five questions.
1. How would you describe the relationship you have with your doctor?
a) Wonderful - they are attentive and take an interest in my life.
b) Normal - they do the bare minimum.
c) Poor - they are very quick and rarely take the time to engage in interaction.
2. How often do you visit your doctor?
a) Never
b) Less than Once a Month
c) Once a Month
d) 2-3 Times a Month
e) Once a Week
3. How often do you do what your doctor recommends?
a) Always
b) Sometimes
c) Never
4. If you answered never to the question above -- why?
a) I think I know what's best for my body.
b) I just didn't feel like it.
c) I don't think it's necessary.
5. Does the way your doctor communicates with you affect whether or not you will follow through with any medications, treatments, or suggestions?
a) Yes
b) No
c) I'm not sure
We received a total of 30 responses and were able to make a conclusion. Most people said that their doctors treatment was 'normal'. Among those who said their treatment was normal, most if not all visited the doctor less than once a month, and said they only do what their doctor recommends sometimes. All of these people agreed that doctor communication affects whether or not they will take their suggested medications/treatments. Those who answered that their doctors treatment was wonderful also visited their doctor less than once a month, but unlike those who were only treated normally, these patients claimed to always do what their doctor recommends (this can prove that the better your doctor treats you, the more likely you are to comply). They also all answered yes to question 5. Of all 12 people, there was one person who claimed their doctors treatment was poor. This person visits the doctor less than once a month, sometimes does what their doctor recommends, and does not believe that the way a doctor communicates with you affects whether or not you will follow through with medications.
From this survey we can conclude a few things. 1) Most people believe they are treated normally by their doctor. 2) Most people visit their doctor less than once a month. 3) Most people either always or sometimes comply with their doctors suggestions and 4) Most people agree that the way a doctor communicates with you can affect whether or not you will follow through with their suggestions.
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Below is a video that we found on youtube that we believe discusses a lot of what we have researched and learned. It's a short video, but very informative!
We can concur from this video that many patients still don't receive full benefits from their medications. This can be because of 1. Lack of education about the disease or treatment, 2. Inability to afford medicine or 3. Lack of adherence to their therapy. A shocking statistic is that according to the world health association, only 50% of patients with chronic conditions take medications as they are prescribed. This not only negatively affects the patient, but it begins to affect the healthcare industry. From the research our group has done, we continue to believe that this is a huge issue in todays health communication. After all, the purpose of health care establishments is to allow those who are ill to receive treatment and recover. However, if healthcare professionals do not know how to communicate with their patients in an acceptable manner, many patients will be put-off and not comply. We cannot point the fingers at only health professionals. It is a persons duty to become as informed as they can about either the medication or illness. The less educated we are about the disease or treatment, the less likely we are to go through with it.
We hope that our research and insight on Patient Compliance has helped you in one way or another. We hope that you now realize the importance of communication in a healthcare setting and the huge impact it can make if not done properly. And most of all--- we hope you can take away something from this and apply it to your life from now on!
Sources:
Mfoafo- M'Carthy, Magnus & Shera, Wes. (2012). Beyond Community Treatment Orders. International Journal of Mental Health, Vol. 41 Issue 4, P62-81.
DuPré, A. (2010). Communicating about health: current issues and perspectives(3rd ed.). New York: Oxford University Press.
Eraker S.A, Kirscht J.P and Becker M.H. (1984). Understanding and Improving Patient Compliance. Ann Intern Med. 100:258-268
