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Preventive Dentistry
Third Year

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  1. 1. ‫بسم ال الرحمن الرحيم‬ Enhancing patient adherence to preventive programs Preventive Dentistry PDS 332
  2. 2. Lecture outline       Terminology Determinants of patient adherence Patient adherence assessment protocols Monitoring patient adherence Strategies to enhance patient adherence Summary
  3. 3. Learning outcomes    Review personal, environmental and predictive factors associated with varying degrees of patient adherence to recommended health behaviors Examine assessment and management protocols to facilitate patient adherence Identify strategies to promote patient adherence to recommended oral health behaviors
  4. 4. Introduction      Prevention of diseases starts with health promotion Lifestyle behaviors and modulation of major life threatening diseases and disorders. Patient adherence has been always looked at as problematic. Non-adherence to treatment regimens is the single greatest reason for hospital readmissions Non-adherence cost in general health.
  5. 5. Terminology       Adherence = Compliance Authoritative relationship between the physician and the patient. In the 1980’s re-enforcement programs based on behavioral psychology In the 1990’s non-adherence = multi-factorial problem “Patient centered” strategies to enhance adherence Personal responsibility for oral health has to be addressed
  6. 6. Determinants of patient adherence    Patient characteristics Patient / Provider and Patient / Parent Relationships Predictive factors
  7. 7. Patient adherence assessment protocols     Tailored approaches and strategies to assess and monitor patient adherence based on individual patient needs. Self- reported behaviors is one method Accurate and objective assessment of adherence by using indices that measure the results of non-adherence Some of the most common indices include:         Plaque index Plaque control record Plaque free score Patient hygiene performance Simplified oral hygiene index Gingival bleeding index and Gingival Index The Periodontal Screening and Recording Index has been reported to be a particular effective tool to assess patient adherence
  8. 8. Monitoring patient adherence     The role of the patient in the process of decision making that involves informed choices and adaptations in self-management. Self monitoring form or log is needed to establish baseline assessment. Patients could be asked to demonstrate oral health home care techniques. Technological advances in monitoring adherence.        Computers Microchips Fiber optics Electronic pill bottle lid The world wide web Text messaging Intra-oral cameras
  9. 9. Strategies to enhance patient adherence  This involves three major components: Specific strategies for targeted health behaviors  Patient education module  Individual- patient focused counseling strategy 
  10. 10. Comprehensive PatientCentered Counseling Programs
  11. 11. Comprehensive PatientCentered Counseling Programs
  12. 12. Strategies to enhance patient adherence  Stage-based models  Three broad categories of patients Have not decided to change  Have decided to change but not taken action yet  Those involved in overt changes   Trans-theoretical Model
  13. 13. Strategies to enhance patient adherence  Motivational interviewing Expression of empathy by the counselor  Development of discrepancies among the pros and cons of a behavior  Rolling with resistance  Support for self efficacy   A serious problem with patient-focused counseling strategies is time consumption.
  14. 14. Summary   The proper identification of strategies tailored to the need of the individual patient The use of the technology available and the promising role of the internet