Patient Adherence and Vulnerability Flashcards
What effects can social characteristics have on vulnerable individuals?
- contracting illnesses
2. creating large obstacles in caring for illness/following treatment plan
Examples of vulnerabilities include:
Economic hardship Limited education Lack of health insurance Minority background Speaking little English Mental illness Limited access to healthcare Mental status Age Violence Alcohol and drug abuse Living in rural areas Living in inner city areas Immigrant status Lack of employment Legal status Transportation problems Homelessness Caregiving for others
What are the three essential strategies that can be used to intervene when vulnerable patients are being affected by their social environments?
- building a therapeutic alliance
- eliciting the patient’s story
- assessing the pt’s psychosocial vulnerabilities and strengths
What are 5 ways you can build a therapeutic alliance?
- mutual trust
- empathy
- respect
- collaboration
- broadening the alliance
Research show that therapeutic alliance leads to better health outcomes and ___________.
increased compliance to medications and Tx regimens.
Vulnerable pt have a history of broken or disrupted human relationships caused by
- lack of trust
- betrayal of promises
- unsafe environments
Empowerment through therapeutic relationship is built for vulnerable populations by practitioners:
“giving them what they do not receive from others”: being transparent/ honest/ upfront, following through, providing time to address concerns
Boundary management is achieved by:
- explaining what you need information for (it may be sensitive information)
- explaining who the information will be shared with
- Not “rescuing” your patient; allowing them to do for themselves what they can (managing your own boundaries)
What items are included in the patient’s perspective/Narrative?
- beliefs
- values
- assumptions
- experience
______________is associated with patient trust, satisfaction, adherence
“Letting the whole story be told”
What are the advantages of eliciting the patient’s narrative?
- builds relationship
- accurate assessments and share understanding
- provides meaning to providers
- allows for the creation of accurate and “do-able” treatment plans
What is the most important reason for variation in treatment outcomes?
patient’s social context
Why is assessing psychosocial vulnerabilities and strengths important?
To understand patient’s social context; why are they noncompliant, difficult, socially “messed up”, hard to deal with?
Trust, sensitivity, rapport, and nonjudgmental reactions are important for assessing…
psychosocial vulnerabilities
What affects does assessing and acknowledging strengths of vulnerable populations lead to?
- increased empowerment
- decreased dependence
- builds therapeutic relationship
Vulnerabilities are _____.
A. Context independent
B. Context dependent
C. Context defining
B. context dependent
The importance of exploring vulnerabilities is to determine…
how they are affecting health and self-care; how to mitigate the affects.
Strategies for assessing psychosocial vulnerabilities and strengths
- show you care
- advocating for pt
- connecting them with resources
- networking with others (family, community)
- self-disclosure when appropriate
Why is self disclosure appropriate during assessments of vulnerable populations?
To encourage narrative sharing, to benefit the pt long term.
What are some examples (3) of patient non-adherence?
- not taking medications (or properly)
- not making behavior changes that are essential
- persisting in harmful behaviors
What is the prevalence of patient non-adherence? (Total, chronic, and lifestyle)
25% total
40-50% LT medication use for chronic diseases
>75% for specific lifestyle changes
What are a few causes of non adherence?
- frustration
- pessimism
- depression
- cognitive deficits
- limited social support
What are the 3 primary causes of nonadherence?
- clinician causes
- patient factors
- clinician-pt interactions
T/F: Personality, gender, ethnicity, social class, and education level affect patient non adherence.
False.
What are 2 examples of clinician factors that cause patient non-adherence?
- behavior that is controlling/paternalistic
2. failure to anticipate and overcome practical barriers
What are patient factors that influence non-adherence?
- not understanding
- low health literacy
- lack of commitment to plan
- depression & hopelessness
- lack of social support
- income (no insurance)
- health/cultural beliefs
- intolerable side effects or other regimen difficulties
What are 3 examples of clinician patient interactions that affect non adherence?
- poor communication
- lack of understanding of Tx or its importance
- lack of trust
Passivity is a sign of _______.
Nonadherence.
Lack of involvement, depression, and unquestioning obediences are signs of ________.
Nonadherence.
T/F: lack of response to treatment is a sign of non adherence.
T
T/F: Consistent responses to treatment are a sign of non adherence.
F; Inconsistent response to treatment are a sign of non adherence.
T/F: a confusing clinical picture is common in patient’s non-adhering to their treatment plans.
T
Why can non adherence be an awkward topic of conversations?
- pt do not want to admit non adherence
12. providers are reluctant to inquire about non-adherence
What are some of the reasons that patients do not like to admit they are non-adherent?
- social pressure to be a good patient
- avoid disappointing provider
- fear criticism
Why are providers reluctant to inquire about non-adherence?
- time
2. difficult subject/ confrontational
T/F: 50% of pt leave offices confused about how to manage their health.
T.
A lack of questioning during discussion of a treatment plan with a patient could mean that the patient _____.
Does not understand the information.
What are 3 ways to increase patient adherence regarding education and understanding of the treatment plans?
- provide written information
- use ask-tell-ask
- spend extra time with the pt
Building rapport and trust is important for ______.
improving adherence
T/F: attending to pt emotional issues and providing them with your full attention will increase pt adherence
T
T/F: the collaborative care model is useful for addressing adherence issues.
T
Patient adherence can be improved by assessing the patient’s belief about the regimen. What questions are you interested in learning about while assessing beliefs?
- do they think the regimen is worth following?
- do they think the outcome will be effective
- do they feel the benefits outweigh the costs?
What are a few ways to increase pt adherence?
- weigh pros and cons of Tx plan
- focus on overall quality of life
- negotiate treatment plan
What are some ways to negotiate treatment plan to increase adherence?
- listen to pt feelings
- discuss pt abilities
- discuss pt preferences
- discuss pt objectives
T/F: your agenda is an important component of assisting patients to increase adherence to treatment plans.
F; keep your agenda out of it
Follow-up increases _______.
accountability
If patients are struggling to adhere to their treatment plans what can PAs do to help?
help incorporate their plan into their life and make referrals as necessary.
