How To Facilitate Better Patient Compliance

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Identifying The Potential For Missed Appointments

Missed appointments are often a frustrating and significant problem for many practitioners. Overall, missed appointment rates have been reported between 10 to 30 percent.

There are some factors that have been studied and linked to missed appointments. For example, patients from large families have been documented as having a greater chance of missing appointments. Patients who have a history of missed appointments and those who were referred by other physicians also may be more likely to miss scheduled office visits. For example, patients referred to the doctor’s office from the emergency room are notorious for a lack of follow-up.

When your staff sees that these patients are scheduled for follow-up visits, it may be prudent for them to make reminder calls a week or so before the appointment. Doing so may cut down on the number of missed appointments and facilitate improved patient compliance.

By Gary M. Rothenberg, DPM, CWS

What You Can Do To Bolster Patient Compliance
You may unknowingly be playing a role in patient non-compliance as well. It’s important to evaluate your own attitude toward patients with diabetes. Is this a population that you enjoy working with or do you view these patients as a burden? Today’s clinicians must adapt from the more traditional biomedical approach and work with patients from a biopsychosocial perspective. It is necessary to accept the patient as a fully entitled partner. Indeed, these patients respond best when there is continuity of care and consistent follow-through.
As clinicians, we are often responsible for demanding complicated medical regimes such as involved and unrealistic dressing changes or treatment modalities. Most people are already squeezed for time with busy schedules and non-compliance can often be the result of poor understanding and such cumbersome requests that the patient will just simply give up.
If you want to influence patient compliance, consider the following keys:
• Explain the logic behind your therapeutic advice.
• Understand patient perceptions about the efficacy of treatment.
• Talk about the patient’s problems regarding continuation of care.
• Determine if treatments may interfere with the patient’s lifestyle.
• Include the patient’s family and other significant people in your education efforts.
• Simplify complex wound care or drug regimens.
• Be specific.
• Provide pre-printed handouts with instructions.
• Help facilitate patients’ search for their own solutions.

Empower Your Patients
Clearly, if you want a patient to be compliant with a particular regimen, there is a high level of education required. The American Association of Diabetes Educators recognizes two theories of diabetes education. The compliance-based approach maintains the health care professional is an expert and patients should comply accordingly. This theory is inherently flawed in that care is unidirectional since I am “telling” the patient what to do and often not giving the patient the “why.”
The empowerment approach is generally more favored today. This theory states that when we give patients all the necessary information, they can make the best decision for themselves based on their own needs, circumstances and expectations. In this regard, patients accept responsibilities and experience their own consequences.
There are a few specific patient populations in which certain influences affect patient compliance. With regard to adolescents with diabetes, the most powerful predictor of compliance is support from nurses. This group may feel less threatened by nurses. They seem to feel the greatest connection and rapport with nurses as compared to physicians.
Polypharmacy is the primary influence on compliance for the geriatric population. One must establish a clear plan for adding new medications and assistance from family or caregivers may be necessary to ensure patients are taking new medications exactly as you have prescribed them.
Also be aware that patients of lower socioeconomic status and specifically those of Hispanic or African-American descent may have issues associated with diets, other comorbidities, access to healthcare and religious beliefs that may influence compliance.

Dr. Rothenberg (left) is a Certified Diabetes Educator who practices in Atlanta.

Dr. Steinberg (right) is an Assistant Professor in the Department of Orthopaedics/Podiatry Service at the University of Texas Health Science Center.

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Anonymoussays: December 8, 2009 at 6:19 pm

It is a good explanation, however it is better to put more on the importance of patient compliance as well.

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