This site demonstrates patient-centered communication skills to assess adherence issues and partner with patients to address them. The skills are demonstrated using 10 second video clips showing provider communication with three different patients.

  1. Around half of the patients who are on treatment for hypertension remain uncontrolled.
  2. One out of two chronic disease patients do not adhere to  some aspect of their treatment regimen.
  3. Causes of non-adherence include inconvenience, forgetfulness, cost, side effects, misunderstanding or confusion, or simply wanting take a “break” from medications (drug holiday).
  4. Providers often hold off making needed changes to patients’ medication regimens because of concerns about medication adherence.
  5. Assessing patient adherence at every visit, using patient-centered communication, allows for honest disclosure by patients, and for more effective treatment planning.
  6. Inclusion of patients in a negotiation process creates buy-in to a workable plan and enhances the likelihood of successful follow-through.
msbass

Use Open and Non-Judgmental Questions:

Opening the discussion with non-judgmental probes conveys permission to patients to talk openly and frankly about their medication and lifestyle habits and to disclose non-adherence. To view more assessment skills, click on the images under ‘more videos’ on the right. To go back and view ‘partnering with patients’ skills , click on the ‘skills’ tab above.
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lewis

Ask Questions Specific to Verifying Regimen

Asking explicitly if patients can identify their medication by name or description, purpose, dose and schedule will identify gaps that may be related to adherence problems. To view more assessment skills , click on the images under ‘more videos’ on the right. To go back and view ‘partnering with patients’ skills, click on the ‘skills’ tab above.
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jackson

Ask Time Specific Questions Regarding Adherence to the Medication Regimen

Asking explicitly about how many pills patients take and at what time of day will identify problems more quickly than asking more general questions. To view more assessment skills, click on the images under ‘more videos’ on the right. To go back and view ‘partnering with patients’ skills, click on the ‘skills’ tab above.
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msbass

Display a Non-Judgmental Response to Patient Admission of Non-Adherence

Patients are more willing to acknowledge difficulties if they do not fear being reprimanded when adherence problems are revealed. A non-judgmental reaction can set a positive tone, allow for fuller exploration of the reasons for non-adherence, and set the stage for problem solving and brainstorming. To view more assessment skills, click on the images under ‘more videos’ on the right. To go back and view ‘partnering with patients’ skills , click on the ‘skills’ tab above.
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reddr2

Explore Reasons for Non-Adherence

Patients are often willing to discuss the reasons for non-adherence if asked, particularly if they think their physicians are open to the discussion and willing to help them problem solve alternative approaches. To view more assessment skills , click on the images under ‘more videos’ on the right. To go back and view ‘partnering with patients’ skills , click on the ‘skills’ tab above.
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jackson

Ask for Patient Opinion Regarding Treatment Recommendations

Ask questions that specifically explore patients’ opinions, preferences, thoughts, and points of view or perspectives relating to treatment recommendations. Include questions that invite patients’ judgment, or ask for patients’ expectations to ensure that any plan includes patient input. To view more 'partnering with patients' skills , click on the images under ‘more videos’ on the right. To go back and view ‘assessment’ skills, click on the ‘skills’ tab above.
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adherance to regimen

Brainstorm and Problem Solve

Brainstorming and problem solving helps motivate patients and better prepare them to successfully implement a treatment plan. Patients who are active in making a plan are more likely to stick to it because the ideas are their own. To view more 'partnering with patients' skills , click on the images under ‘more videos’ on the right. To go back and view ‘assessment’ skills, click on the ‘skills’ tab above.
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lewis

Make Partnership Explicit

Make statements that convey the physician's alliance with patients in terms of help and support, decision-making, or development of the therapeutic plan. To view more 'partnering with patients' skills , click on the images under ‘more videos’ on the right. To go back and view ‘assessment’ skills, click on the ‘skills’ tab above.
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adherance to regimen

Check Patient Understanding of Regimen and Instructions

Make explicit check-ins with patients to verify that instructions and information are clear and understood. This is the most effective way to know if you have communicated clearly and the patient is prepared to follow through on your recommendations. To view more 'partnering with patients' skills , click on the images under ‘more videos’ on the right. To go back and view ‘assessment’ skills, click on the ‘skills’ tab above.
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