Preventive Dentistry Third Year

1. ‫بسم ال الرحمن الرحيم‬
Enhancing patient
adherence to
preventive programs
Preventive Dentistry
PDS 332

2. Lecture outline
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Terminology
Determinants of patient adherence
Patient adherence assessment protocols
Monitoring patient adherence
Strategies to enhance patient adherence
Summary

3. Learning outcomes
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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. Introduction
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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. Terminology
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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. Determinants of patient
adherence
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Patient characteristics
Patient / Provider and Patient / Parent
Relationships
Predictive factors

9. Patient adherence assessment
protocols
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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:
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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

11. Monitoring patient adherence
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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.
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Computers
Microchips
Fiber optics
Electronic pill bottle lid
The world wide web
Text messaging
Intra-oral cameras

12. Strategies to enhance patient
adherence
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This involves three major components:
Specific strategies for targeted health
behaviors
 Patient education module
 Individual- patient focused counseling
strategy
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13. Comprehensive PatientCentered Counseling Programs

14. Comprehensive PatientCentered Counseling Programs

15. Strategies to enhance patient
adherence
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Stage-based models
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Three broad categories of patients
Have not decided to change
 Have decided to change but not taken action yet
 Those involved in overt changes
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Trans-theoretical Model

17. Strategies to enhance patient
adherence
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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
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A serious problem with patient-focused
counseling strategies is time consumption.

19. Summary
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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