Friday, May 30, 2008

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)