Standardized, Patient-Centered Narratives Promote Medication Compliance

It's the frustration of parents, teachers, doctors, dentists, and therapists everywhere: whatever you say seems to go in one ear and out the other.

What can be done to help that problem, to help your patients take that pill, do those exercises, or just to do what you ask, and what you know will truly help them?

I've done a fair amount of clinical observation in the last few years, and I can say that while providers genuinely do care about their patients, along the way, some basics may have been forgotten: 1) Learning takes time, and under physical or emotional stress, learning takes longer.

The patient came to you, because he or she was ill. The visit is in and of itself, a disruption, or dis-ease, compared to their normal routine. Now imagine the struggle to navigate to a new office, under the influence of the flu.

Chances are your perceptual, cognitive, and memory skills won't be top-notch in these conditions. Chances are also high that the caretaker, if there is one, will be equally out-of-sorts.

2) Find redundant ways to reinforce the message to your audience.

This is a total steal from the world of human factors. Just as any (successful/usable) interface is made more accessible for users when multiple pathways are offered for successful completion, adding redundant information that reaches users in their preferred channel will substantially aid users in building and confirming their understanding. The more research I do in the area of perception, the more I realize how widespread and unrecognized these perceptual issues have been. Find compassion for others by providing those multiple channels, and watch your patients mysteriously thrive under your care in new ways. Channels include, but are not limited to:

• Spoken explanation (more on that in a minute)

• Written explanation

• Pictures

• Videos

3) Talk about the disease, symptoms, treatment progression, and the impact they can make on themselves, in terms that they understand, seem feasible, and value.

This leads to this blog's title, and it also references an article that inspired me tonight. In a study by researchers at the University of Illinois at Chicago, they found that presenting an interactive set of scenarios to patients on a tablet, prior to their follow up heart stent appointments, improved medication compliance.

In the world of health care, compliance is kind of like the Grail. The researchers presented stories of other patients who'd also undergone the heart stent procedure, and the scenarios depicted stories of financial challenges (and strategies for overcoming them), poor adherence, side effects, distant family or friends, just to name a few.

This information can be more familiar than reading a list of side effects, and that which engages is far more likely to influence than something that remains unread.

4) Teach patients to recognize what better feels like.

One only appreciates the miracle of having a nose when it is stuffy. As you get better, you forget that you were sick. Sometimes treatment is like that, too, because change can be gradual. You may not realize that you are feeling better, so you stop taking it, because you don't feel a major change.

It may help to have some objective measure, and one that the patient can do at home, to help build trust in program of treatment, and in that trust, build compliance.

5) Find a way to deliver your message, in a reliable, repeatable way

This recently happened to me in a certain doctor's office. The treating provider explained what I needed to do and sent me home. It was only when I got home that I realized that it wasn't self-evident in how to set up the equipment, and since the kit was probably last updated in the 60s, there was no recent documentation for it online.

Sometimes it's easy to forget small details. Sometimes the wrong word will be spoken and/or remembered by the patient.

Therefore, this gets back to the necessity of redundant messaging. Provide standardized instructions, to make sure you don't miss anything. Provide ways for the patient to review materials via multiple channels, when they're not sitting in front of you.

To do this, you must sit down and document what you'd say to the patient, and then have the final products of those materials at the ready, when a patient is sitting in front of you. It's fine that you know the technical names for the muscle group or condition; say it in ways that the patient can use and understand.

6) Follow up.

I recently read about a student who'd been sent home with special equipment to assist him, as a low-vision student, to read within the classroom.

Two years later, the child's educator was undoubtedly mortified to learn that the piece of equipment she was removing from the device because she thought it was a lens cover was actually a magnifying lens to aid the child when reading.

So follow up - and ask for redundant documentation. Chances are, if the health care provider had followed up with the teacher, shortly after the equipment went home with the student, the teacher would report that the student was using the equipment.

Ask for photos. Solicit room for feedback about not just whether the treatment is use; ask about their experiences, questions, and pain points. That's far more useful information.

7) Give your patients permission to say, "It's not working"

This is the flip side of building awareness of whether a treatment is working and the patient can self-report improvement. By creating a trust relationship, where it's ok to say these words, the patient is empowered to be an active participant in advancing their health, and patients and providers can become partners in creating health.

If the patient is following the treatment and no effect is seen, or if the patient has poor compliance to the treatment and no improvement is seen, either way, the provider needs to know, so as to redirect efforts.

In short, the compliance problem doesn't begin and end with the patient; we need to be mindful that we as providers, teachers, parents, and so on are also equally responsible for creating the framework to support compliance.

#Value #Usability #MedicalDevices #HealthCare #Empowerment