Friday reflection

[Adel Elmoghrabi]

As we aspire to establishing a joint partnership with our patients to ensure adherence to our management plan, we frequently run into significant barriers one of which I would like to discuss which is a health system factor such as a system-based appointment length. Unfortunately worldwide, medicine has become run as a business which dictates an increasing number of patients to be seen with resultant shorter durations spent with each individual patient. This raises a tremendous challenge of ensuring a transparent and detailed treatment plan where the patient experiences a joint decision making process during which he/ she would be more willing to participate and adhere to their plan of care. Additionally and unfortunately, physicians are not reimbursed on such provision of care and health care systems are hence built to see increasing number of patients to generate appropriate revenue and reimbursement. I believe that it is very important that our healthcare system may benefit from significant reform if more time is allocated during patient visits to ensure that patient satisfaction and partnership and all physical /mental and social determinants of health are addressed.

[Carli Denholm]

It is important to make a distinction in our thinking between adherence and compliance. Compliance is a patriarchal view of patient behavior where patients do not do what they are told. There can be many reasons for a patient to be “noncompliant” which need to be explored and addressed. We need to work with our patients and learn about their social determinants of health so that we can make plans WITH them. When we make plans with the patient around their needs, we give them the best chance of being adherent and actually make a difference in their health. You can make plans for your patient all you want, but if they are not able to be adherent to the plan, such as not having transportation to appointments or not enough income to pay for their medications, then you are not doing them any favors and you can harm their relationship/trust with the healthcare field.

[ABDELRAHMAN M AHMED]

Exploration of the reasons that lead to non adherence to treatment plans is of paramount importance to guarantee the success of preventive and therapeutic measures. From my personal experience , lack of communication among others) between the medical team and the patient are the cause in many cases.

[Hassan Mohamed]

Of the many factors that determine patients adherence to healthcare plan, the most disappointing factor is the system-based appointment length. As physicians, our duty is to provide the best medical service possible and help patients maintain healthy living. This may come in the form of performing procedures that improve quality of life, or just as important, in the form high quality patient counseling and education that may increase patient adherence and possibly avoid the need for such procedures. Unfortunately, current health systems provide reimbursements in such procedures, but almost none to the latter. This underlines the health systems decreased importance to adherence-focused interventions, which is reflected in the amount time providers spend on patient counseling and education. Change at an institutional level is required in order improve this health system factor of patient adherence

[mowyad_khalid]

Compliance is one of the cornerstones of healthcare improvement. Exploring reasons for non compliance is important. As, the factors sometimes may overlap. As providers we can help as much as we can including educating the patient about the importance of the it, providing resources to help. Also, it is everyone’s responsibility including support staff such as nurses, and clinic managers.

[Ahmed Yeddi]

One thing about adherence is communication between providers. Sometimes we reconcile meds with patients without realizing that their cardiologist or nephrologist changed some sort of medications and can be challenging if patients continue using both meds of the same class from both primary care aand other speciality clinic. I think it’s very useful to send faxes or emails between providers and patients need to be aware of these changes. The point I wanted to bring is that we need to be part of adherence and don’t get biased about patient role.

[Pranav Shah]

It’s quite eye opening how adherence and compliance play such a role in a patient’s health. I think placing all blame on physicians or even placing all responsibility on physicians to make sure patient’s adhere to medications is unreasonable. Patients must also be held responsible for their non-adherence. That being said – I think physicians should not just think that merely saying: “Take this medication” is enough to comply to the idea of adherence.

This past week I have experimented with medication understanding and asking every patient how/why they adhere to their medications. Many patients expressed having difficulty maintaining their medications that deal with chronic illnesses that are asymptomatic. Patients stated that having measuring tools for them helped them with their compliance. Having a blood pressure cuff for hypertension, a glucometer for diabetes, and a home weight scale for obesity all helped patient comply with their medications.

When asked what physician could to do to help with adherence, patient commented on: describing the need for each of the medications, the duration that they may need their medications, and what are the disease goals to strive for. Patients also commented on goal-based approach to disease and medications and stated that this would also inspire more strict adherence.

[Jasleen Kaur]

I believe that social determinants series affecting the patients is a reinforcement to me to care for my patient better as a whole.
A patient came to the clinic with HbA1c was 11.4 with no follow up since many months. She felt fine otherwise and stated that she did not like the idea of taking medications. Anyone would conclude that nonadherence is the concern and a huge problem, but doctors failing to educate their patients was not only a major cause.
I believe, there are many reasons for nonadherence —a desire to do things “naturally,” pills represent reminders of their sickness, depression, social issues within families, self-experimentation with stopping medications and noticing no change in perceived health, and most important drug costs.
I try to have a continuous multimodal approach to it. I continue to provide a 2-minute talk of risks vs benefits and help some ancillary burden lift off them.
I believe that strong Social worker support (even in the clinic) could provide reinforcement as person to person visit to discuss insurance or travel issues, have dedicated psychologist to understand their mindset, etc.

[Antonio Smith]

I had the pleasure of taking care of a young patient in the ICU for hypertensive emergency. She was discharged 3 days and followed up with me in clinic two weeks thereafter. Her adherence her htn management was spotty and she was lost to follow up before she presented to the ICU. I used the teach back method so that I could say with confidence my counseling was solid. She came to our visit with a notebook full of blood pressure recordings. She even calculated her daily sodium intake to ensure it was at or below 2 grams! She had the most beautiful bp anyone can have during her follow up visit and memorized all of her blood pressure medications and doses. This visit was probably the most gratifying of the week. It felt good to address adherence before an issue raised.

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