Communication Strategies#1 Strategy:Talk, Care and Connect

Create A Favorable EnvironmentEstablish PrivacyReduce Physical Barriers

Size-Up the Persons:CredibilityHealthKnowledgeIntellectPersonalityEmotional Status

Determine BeliefsCultural influencesBeliefs about illnessValue of illness

Recognize and Adapt to Persons Internal NoiseHigh anxiety persons: Share overall conclusions firstLow anxiety personsBuild toward conclusion

Employ Positive Non-Verbal BehaviorsForward leanSilencelistenGood eye contactWarm expressionPostural synchronyOpen posture (uncross arms)Limit self-adaptors (touching self)

Build a Two-Way Communication PartnershipAdult-Adult: Empowers ChoicesInformationInsightEmpathyConfidenceParent-Child: Gives AdviceChild-Child: Makes Demands

An Adult Approach.Im here to help you get the most benefit from your medication.

Avoid I-It RelationshipsMartin Bubers SchemaI-IT Impersonal; doesnt acknowledge personI- You Businesslike, professional or personalI-ThouEmpathetic with great understanding

There is No Substitute for Genuine Caring!!Show real empathy Personalize the messageUse the patients nameEngage them in the conversationIdentify and relate to their needs

Create CredibilityPresent a Professional AppearanceAssume a Professional AffectEstablish TrustGo slowFollow-throughDisplay genuine interestAllow the person to save faceEstablish Appropriate Distance and Boundaries

Introverted PharmacistsAchieve Greater Compliance They are perceived as More trustworthyLess overbearing

HelpfulCommunication FactorsFor Better Adherence Deliver:Explicit and appropriate instructionsMore and clearer informationMore and better feedback

Organize the SessionIntroduce self and provide a brief orienting statementAssess the persons anxiety and beliefsPrioritize and structure information- giving to span 3-5 main pointsEmploy transitions between ideasClosingSummarize key pointsProvide written information, even to the most educated patient

Strategies to Detect Non-AdherenceGather Objective DataRefill information and objective lab valuesInterview Person but not via an inquisitionBrown-bag ProgramsPatients bring all of their medications in a bag to the pharmacist for counselingCompliance Clinics

Verbal StrategiesSpeak ClearlyAvoid jargonExplain WHY/WHY NOTLimit message lengthEstablish 3-5 key messagesRepeat important content

Probe for UnderstandingThis is an ethical responsibilityThe basic and most common cause of non-compliance is the patient who does not understand that is expected.Frank E. Young MD Ph.D.

Former FDA Commissioner

Strategies to Verify UnderstandingGentle ProbesWhat will you do? Show me.Why?Ask the person to review the content of your counselingAsk the person to predict the medications effects

Provide Information-Pt 1Be persuasive!Describe useInform about side effectsResearch shows: this does not increase side effectsTell when and how medication will helpAvoid being too complicated or detailed

Provide Information-Pt 2Explain benefits of medicationRaise awareness of body cuesExplain ways person can self-evaluate therapyHelp develop coping mechanismsDont insist that the patient comply

Communicate ViaMultiple Modalities SpeechWritten materialsbe alert to non-readersGraphicsModelsDemos

For best results: employ both oral and written presentations

Build Message RedundancyT1 --Explain what you will tell the patientT2-- Tell itT3 -- Review what you told them

Communicate FrequentlyEncourage future communicationSuggest calling to discuss concernsRefill counseling is an important opportunity to:Identify changing beliefs about illnessIdentify side effects which may lead to non-adherence

Enlist OthersWork with MD to:Simplify regimenReduce number of daily dosage intervalsAdjust to persons daily routineEnlist family support

Be CreativeSupply medication remindersOrganizersAlarmsCheck-off sheetsContractsRemind of refills by mail or telephone

Its Not Just About InformationThe lower the patient satisfaction with the interaction, the greater the likelihood of non-adherenceThere is no substitute for a warm and caring relationship

Therefore, Provide BothAccurate Factual InformationPositive Emotional Aspects

Human Interaction Increases AdherenceNon-adherence was reduced by 25% when the pharmacist, rather than the clerk, handed the medication to the patient.Patient involvement increases adherence

In closingWe have discussed the differences between patient compliance, and patient adherence. The latter is a more complex and inclusive construct.We also considered several reasons why patients do not adhere to treatment regimens, and how healthcare professionals can employ effective communication strategies to increase patient well-being.