Consultation Skills& Patient Centred Care Flashcards
WHAT IS ADHERENCE?
The extent to which the patient takes their medication as it has been prescribed (includes: Initation, Implementation, Persistence and Discontinuation).
WHAT IS CONCORDANCE?
Process of shared decision making about treatment
WHAT IS COMPLIANCE?
Olf-fashioned term for adherance but implies that the patient should do as the doctor tells them!
WHAT FOUR THINGS/STEPS DOES ADHERENCE INCLUDE?
- Initation (collecting treatment and taking the first dose). 2.Implementation (Timing, drug holidays, diets, doses etc) 3. Persistence (Taking the full course). 4. Discontinuation
IMPACT OF NON-ADHERENCE ON HEALTHCARE SYSTEMS
- Cost of treating complications
- Hospitalisation
- Regimen changes
- Emergency care
- Increased primary care treatment seeking
Also increases burden on family members, lost work days etc
PAPA
WHAT IS UNINTENTIONAL NON-ADHERENCE?
Where a patient can’t take the treatment
WHAT IS INTENTIONAL NON-ADHERENCE?
Where the patient won’t take the treatment
EXAMPLES OF PERCEPTUAL BARRIERS
- Afraid of the side-effects
- May feel that the medication is unnecessary
- May forget/can’t be bothered
EXAMPLES OF PRACTICAL BARRIERS?
- May not have a pharmacy/doctors nearby to get the medication from
- May have mobility issues that inhibit you from delivering the drug (e.g. arthritis sufferers may be unable to use an inhaler).
BELIEFS ABOUT MEDICATION: THE NECESSITY-CONCERNS FRAMEWORK
BELIEFS ABOUT MEDICINES
WHICH OF THESE BELIEFS ARE ABOUT WHAT MIGHT HAPPEN?
- Having to take medicines worries me
- I sometimes worry about becoming too dependent on my medicines
- My medicines are a mystery to me
- I sometimes worry about the long-term effects of my medicines
- My life would be impossible without my medicines
- My health in the future will depend on my medicines
- Without my medicines I would be very ill
- My medicines protect me from becoming worse
- My health, at present depends on my medicines
2,4,6
Our personal representations of illness develop from exposure to many social and cultural sources of information, such as newspapers, education, personal experiences, the illness experiences of those close to us.
Some representations are abstract e.g. in the form of words such as these medicines will help my migraines, to concrete, emotionally evocative images such as vivid memories of experiencing the pain itself.
WHAT DOES THE ILLNESS COGNITIONS MODEL CONSIST OF?
- Identity
- Cause
- Timeline
- Consequences
- Contrallability&Curability
WHAT DOES THE HEALTH BELIEF MODEL CONSIST OF?
- Perceived Susceptibility
- Perceived Severity
- Perceived Benefits
- Perceived Costs
- Cues to Action
- Health Motivation
KNOWLEDGE GAP FORMS
- Not knowing how illness works
- Not understanding how treatment works
- Not knowing how to take it (e.g. can I drink alcohol, use heavy machinery, dose, frequency, timing etc)
- Not knowing what side effects it has
- Not knowing what to do if it has side effects
- Not knowing what to do if you miss a dose
ARE PATIENT BELIEFS ABOUT MEDICINE EVER WRONG?
NO.
- Their beliefs are valid – no matter how irrational they seem to you
- They have a life’s experience of THEIR health (you should tap into this rich source of information)
- Their beliefs are developed from their experiences & knowledge which are gathered from a huge range of sources.
- Patients do their own cost-benefit analysis on the good / bad points of taking a medicine
- They have to fit medicine-taking into their everyday life – which as we have seen it is not necessarily as easy as it may first seem.
WHAT IS THE NEW MEDICINES SERVICE AND WHAT DOES IT DO?
It is a specific clinical service targetting the main issues of intentional and unintentional adherence.
Targeted at: Asthma, COPD, T2 diabetes, hypertension etc
NEW MEDICINES SERVICE CONSULTATIONS
How the NMS works:
- Prescription for new medicine – pharmacist provides the normal counselling on this new medicine to patients
- Patient invited to meet with the pharmacist between 7-_ days after starting the new medicine (typically this is in person)
- Patient invited to a follow-up meeting (or pharmacist telephones the patient) a further 7-14 days after treatment initiation (so after 4 weeks in total)
14
MEDICINES USE REVIEW
Similar to an NMS – but aimed at:
- For patients regularly taking more than one prescription medicine
- Patients with long-term conditions (e.g. asthma)
- Patients recently discharged from _
The focus is on identifying issues with _ taking that have developed over time as their condition has changed/ developed / other things happened in their lives
Hospital
Medicine
WHAT IS THE PURPOSE OF A MEDICINES USE REVIEW?
Identify issues with medicine taking that have developed over time as their condition has changed/developed
HOW TO EXPRESS EMPATHY
- REFLECTIVE LISTENING SKILLS (open questions, reflections, summaries, non-verbal communication)
- Affirm that it is good that they have told you there is a problem
- Be non-judgemental (don’t _ the patient)
- Be collaborative (not directive)
- Be friendly
- Find out what their illness / taking this medicine means for them
Blame
WHAT IS A CONSULTATION?
Any health-related conversation you have with a patient, customer or carer
PERSON-CENTRED CONSULTATION
CONSULTATION SKILLS MODEL
WHAT IS THERAPEUTIC EMPATHY?
The ability to identify an individual’s unique situation (perspective, feelings, opinions, ideas), to communicate that understanding back to the individual and to act on that understanding in a helpful way
CALGARY-CAMBRIDGE CONSULTATION MODEL
WHAT ARE THE FIVE STEPS OF THE CALGARY-CONSULTATION MODEL?
- Initiating the session
- Gathering information
- Physical examination
- Explanation and planning
- Closing the session
