Lack of Tailored Counseling Causing Racial Disparities?

A recently published study assessing racial differences in diabetes management in the US has revealed marked racial disparities in patient outcomes, independent of treating physician. The author suggests the discrepancy may in fact be due to a blanket approach by physicians. I.e. Far from discriminating, instead doctors are treating all patients similarly without acknowledging possible socio-cultural effects on treatment.

"I feel like the issue may more be that the doctors are treating all the patients the same — and if you treat all the patients the same you won't get the same outcomes because patients don't face the same challenges," he says. "We're not tailoring our counseling to the needs of our patients" says Thomas Sequist, lead author of the study and an internist at Harvard Vanguard Medical Associates.

Family Influences and Heart-felt Care

A recently published review of the effects of family on the self-care habits of heart patients has concluded that the family, as an integral social institution, is a protective factor, improving proper self-care. Those without strong social support are “highly vulnerable” and may be targeted as having increased risk of non-adherence.

Pharmacists & NRx Patients: Short Call Goes a Long Way

In a trial with 480 patients, a simple 12-minute call made by pharmacists had a significant effect on patient adherence. Calls were based on a semi-structured interview involving general introductory questions ('How are you doing with your medication?') followed by a discussion dictated by patient needs. Result: 50% fewer people were non-adherent in the intervention group. Reported complications were also lower, and belief in necessity of medication was higher, in the intervention group. At 4-week follow-up patients stated the pharmacist call had been quite useful.
Link to abstract

Cancer Treatment: Adolescents Rebel Against Compliance and Control

The adolescent population poses a unique set of challenges to health care professionals through their resistance to rules and compliance. Even in cancer treatment adherence can be difficult and requires family and social involvement in addition to the full cooperation and involvement of the adolescent in treatment.

Intentional Non-adherence Founded on Beliefs and Concerns

Patient beliefs about medication risk and necessity have an enormous impact on their motivation, adherence and persistence. Researchers in this recent study have found that increased belief of risk and decreased belief in necessity are primary differences between intentional and unintentional adherers. Authors suggest addressing these groups with different interventions according to their unique barriers to adherence.

Vancouver Study: 28% of Medication - Related ER Visits Caused by Non-adherence

In a study of 1,194 patients at Vancouver General Hospital, 68% of medication-related emergency room visits were preventable. The most common reasons for drug-related visits were adverse drug reactions (39.3%), nonadherence (27.9%) and use of the wrong or suboptimal drug (11.5%).

Top admissions distributed by drug class:
CNS agents (40.8%)
Cardiovascular agents (12.8%)
Antimicrobial agents (11.2%)

Authors recommend:
"Future research should focus on interventions to optimize communication between health care professionals in acute and ambulatory settings and to improve patients' adherence with prescribed medications."

"The optimal strategy may involve interventions outside the hospital to improve prescribing practices and monitoring, particularly among high-risk patients or patients taking high-risk medications"

Diabetes: Patient Perceptions and the Stages of Change

In diabetes care, a patient is often faced with several essential lifestyle changes. This study evaluated the usefulness, according to patient subjective responses, of a tele-health support intervention based on the Stages of Change (from TTM). Patients found the tele-health support using the SoC approach to be useful for their required lifestyle changes. Most important early applications were consciousness raising and self-evaluation. Later, contingency management was more useful. Throughout the intervention self-efficacy and organization improved and the supportive relationship was highly valued.

Trans-Theoretical Model

This study evaluated the continuity of intermediate behaviors across the Stages of Change according to the Trans-theoretical Model. Behaviors were analyzed for adolescents switching to a low-fat diet in the UK. While diet and planned behaviors improved linearly, ambivalence increased towards the preparation stage and was reduced as participants moved through action and maintenance. Authors emphasize the need to retain motivation and vigilance towards relapse to ensure successful behavior change.

Applying Good Psychology to Dynamic C&P Programs

The most common psychological approaches to C&P include Motivational Interviewing (MI), which allows the patient to discuss their beliefs and barriers to medication adherence. It emphasizes the need to "roll with resistance," and not change on the individual. The Health Belief Model is similar to MI and emphasizes patient beliefs, choices and needs. Stage models, on the other hand, view behavior change as a series of steps, each of which comes with its own challenges and new skills. Other techniques include personalized educational interventions, reminder systems and tracking tools to provide patients with new skills and help with recall and organization.

At Pleio, we draw on these strategies to support the challenges patients face, the short-term goals we intend to reach, and the properties of the media and channels at our disposal. We pay attention to both cognitive and emotional drivers of change, and like to encourage family and social support when appropriate. The Pleio Approach addresses:
1. Culture (language choices)
2. Patient Readiness (confirmed through phone contact and brief questionnaires)
3. Motivation (internal better than external)
4. Knowledge (belief in diagnosis, understanding of condition and medication)
5. Skills (ability to administer medication correctly, develop reminders, speak assertively)
6. Tools (automated reminder system, patient-physician discussion guides)
7. Rehearsal (peer support exercises where patient develops confidence, assertiveness)
8. Reinforcement (of external and ideally internal goals)
9. Rituals and habits (associating dosing with other habits already entrenched)
10. Feedback (rewarding patients with personalized information they can apply and share)

Motivating Change in OCD Patients

In psychological treatment, as with pharmaceutical treatment, adherence and barriers to change are substantial hurdles. A recent study demonstrates the successful use of Motivational Interviewing to enhance patient participation and engagement in standard psychotherapy for obsessive-compulsive disorder. The results were decreased symptoms and increased quality of life. As an adjunct to symptom-targeting therapy, motivational interviewing was very effective.