This presentation addresses factors that influence adherence to medical treatment regimens; provides a model for assessing non-adherence risks and lists recommendations for staff intervention.

1. PSYCHO-SOCIAL DETERMINANTS OF TREATMENT
ADHERENCE
Anita L. Dottes, LCSW
Dottes’ Seminars & Communications
Ridgeland, Ms.

2. OBJECTIVES:
 IDENTIFY PSYCHO-SOCIAL
DETERMINANTS OF TREATMENT
ADHERENCE;
 DELINEATE INTERVENTION
STRATEGIES TO ADDRESS ADHERENCE
RESISTANT PATIENTS;
 ADottes

3. NON-ADHERENCE …
HOW IS IT DEFINED?
 MEDICAL STAFF PERSPECTIVE
 PATIENT PERSPECTIVE
 ADottes

4. MEDICAL/STAFF
PERSPECTIVE
Non adherence is . . .
 NOT FOLLOWING RECOMMENDATIONS RE:
RXS, DIET, EXERCISE, MEDICAL FOLLOW-
UP, OTHER TREATMENT REQUIREMENTS
 DETRIMENTAL TO OVERALL TREATMENT
OUTCOMES
 ADottes

5. PATIENT PERSPECTIVE
Non adherence is influenced by:
 EMOTIONAL ISSUES related to illness
adjustment
 INTELLECTUAL/COGNITIVE ISSUES
 PRE-DIAGNOSIS LIFESTYLE BEHAVIORS
ADottes

6. IMPACT OF NON-
ADHERENCE
↑MORBIDITY
↑MORTALITY
ECONOMICS

7. WHAT FACTORS INFLUENCE
TREATMENT ADHERENCE?

8. LIFE PERSPECTIVES & HEALTH
BELIEFS
 QUE SERA, SERA
LOCUS OF CONTROL . . .
INTERNAL VS. EXTERNAL

9. PSYCH0-EMOTIONAL
ADJUSTMENTTO ILLNESS

10. SUPPORT SYSTEM

11. RESOURCE AVAILABILITY
Health care costs!

12. INTELLECTUAL &
COGNITIVE COMPETENCE

13. ASSESSING RISK FOR NON-DHERENCE
 HIGH ►
MODERATE/AVERAGE ►
LOW►

14. HIGH RISK INDICATORS
 POOR PRE-DIAGNOSIS HEALTH
MAINTENNANCE HABITS
 LIMITED/INADEQUATE SOCIAL SUPPORT
 INTELLECTUAL/COGNITIVE CHALLENGES

15. HIGH RISK INDICATORS contd.
 PSYCHO-EMOTIONAL ADJUSTMENT
ISSUES
 AGE
 TREATMENT FACILITY CULTURE

16. MODERATE RISK
INDICATORS
 AVERAGE PRE-MORBID ATTENTION TO
HEALTH MAINTENNANCE, e.g. regular
screenings
 OCCASIONAL/INTERMITTENT NON-
ADHERENCE . . . situational & short-lived

17. Low risk
 CONSISTENT PRE-ESRD FOCUS ON HEALTH
MAINTENNANCE
 MOTIVATION/COMMITMENT
 GOOD RESOURCE AVAILABILITY
 GOOD SUPPORT SYSTEM
 HX OF EFFECTIVE COPING

18. STAFF INTERVENTION STRATEGIES:
1. ASSESS YOUR PERSONAL &
PROFESSIONAL MINDSET
Unrealistic
Idealistic
Realistic
2. DEVELOP EFFECTIVE RELATIONSHIPS
3. AVOID THE “us vs. them” TRAP
ADottes

19. INTERVENTION STRATEGIES
CONTD.
4. INDIVIDUALIZE, don’t GENERALIZE. . .
one size does not fit all.
5. BE INNOVATIVE . . . But keep it simple.

20. SUMMARY/CONCLUSIONS

21.  ADHERENCE IS NOT merely A MATTER
OF EDUCATION.
 ADHERENCE . . . IS INDIVIDUAL, &
INDIVIDUALIZED PATIENT ASSESSMENT &
INTERVENTION ARE REQUIRED.

22.  EDUCATION, MOTIVATION &
COMMITMENT ARE INTERDEPENDENT
REQUIREMENTS FOR ADHERENCE.
 DON’T GIVE UP . . .
BELIEVE IN THE POWER OF EPIPHANIES!