There are many reasons why patients resist following instructions, but a comprehensive approach can help doctors change behavior.
One hurdle in treating patients, particularly children and teens, is ensuring compliance with treatment protocols. It can feel like an uphill battle, but there are things you can do to improve your patients’ adherence level.
According to Steven R. Feldman, M.D., Ph.D., professor of dermatology, pathology, and public health sciences at Wake Forest University School of Medicine, there are many reasons why patients resist following instructions. But, a comprehensive approach can help you change their behavior.
He offered tips on working with patients with atopic dermatitis at the American Academy of Dermatology 2018 Summer Meeting.
WHY PATIENTS RESIST
Overall, if patients aren’t implementing your guidance, he says, it’s likely for one of these reasons:
1. Lack motivation or the condition isn’t bothersome
2. Seeking some other gain
3. Distrustful of you
4. Scared of the medicine or treatment
5. Forgot your instructions
6. Treatment is more burdensome than disease
7. Treatment is believed to be worse than disease
8. Forgot to use the medicine
9. Lazy or couldn’t be bothered
10. Give up after trying the treatment
CREATE AN ADHERENCE PROTOCOL
It’s possible to improve how well your patients follow your instructions, though. Feldman recommends establishing a system to encourage adherence from the first visit.
Schedule follow-ups: Patients are more likely to fill prescriptions and use medications if they know they’ll see you again soon. In fact, Feldman cited a study showing a 1-week return visit was more effective in prompting kids to apply 0.1% tacrolimus ointment than parent or electronic reminders.
Simplify treatment: Make the protocol as easy to follow as possible. If it requires too many steps, patients are less likely to do it.
Written plan: Don’t rely on patients’ memories. Give them written instructions that include an explanation of their condition, treatment tips, guidance for managing flare-ups, and details on when to call you.
Create Triggers: Calendar and digital reminders can be effective tools in facilitating patient compliance. Additionally, “barrier” triggers, such as putting anti-fungal creams on top of a sock drawer, or special packages, such as weekly pill boxes, can also be helpful.
Create motivation: Provide positive feedback, such as sticker charts for young children.
Employ teen psychology: Don’t acknowledge teen non-compliance. Instead, talk about medications teens use frequently or about reminder systems that work well for the age group.
Offer anecdotes: Share success stories to help them feel comfortable with a treatment.
Concentrating on patient adherence might not be your primary focus, Feldman says, but with the right compliance protocol you could be as effective in helping patients stick with treatment as you are providing a diagnosis.
Steven R. Feldman, M.D., Ph.D. “Optimizing Topical Therapy in Atopic Dermatitis,” American Academy of Dermatology 2018 Summer Meeting, Chicago, Ill., July 29, 10a.m.-1p.m.