To promote better adherence, should greater emphasis be placed on changing patients’ beliefs? This post explores why changing beliefs may be a key component in interventions to improve medication adherence.
A news release on adherence and patient beliefs recently caught my eye. It came from Atlantis Healthcare, a company that uses health psychology to encourage better adherence. The rationale for this approach goes like this:
- Non-adherence is often intentional – ie, patients deliberately choose not to take their medications.
- Frequently, this decision is driven by unhelpful beliefs – either about the patient’s condition, or their medication, or both.
- Psychology-based interventions can help overcome false, limiting, or unhelpful patient beliefs.
- Psychology-based approaches can also help motivate patients to change their behaviors and achieve better adherence.
Dr Scott Guerin of Atlantis Healthcare summarizes the rationale as follows:
“Patients need to be empowered to better self-manage their chronic illness – and successful programs need to go beyond support and simple reminders to shift patient beliefs to improve adherence behavior for the long-term.”
Comments on the Need for Psychology-based Interventions
So how strong is the need for psychology-based interventions? In part, the answer to this question lies in how often psychology-based reasons drive non-adherence. In this context, psychology-based reasons include not only patient beliefs, but also patient motivation, attitude, and self-efficacy.
An analysis of non-adherence reasons appeared in a recent post (see here). Drawing on nine sources for reasons for non-adherence, it ranked our four ‘reasons-of-interest’ as follows:
|Psychology-based Reason||Mean % Impact on Non-adherence||Overall Reason Rank|
|Patient motivation||27%||2 nd|
|Patient beliefs||12%||Equal 6 th|
|Patient self-efficacy||7%||13 th|
|Patient attitude||5%||14 th|
For further comparison, “forgetfulness” was the most common reason for non-adherence (31%), “cost” was 3rd (22%), “poor physician-patient relationship” was =6th (12%), and “medication complexity” was 12th (8%).
So psychological reasons for ARE important considerations when healthcare providers are seeking to achieve better adherence.
There’s another reason to put a priority tag on dealing with psychological reasons. Because the issues are all internal, patients cannot easily solve them on their own. Whether it’s false beliefs, or low motivation, or poor self-efficacy, patients need help to get themselves back on the right track.
So healthcare providers (HCPs) need to get involved!
It’s now generally accepted that multi-component solutions are needed to drive better adherence. The specific elements within each multi-component solution should be customized to individual patient’s needs. And these needs will be strongly influenced by a patient’s reasons for non-adherence.
Given the percentage of patients reporting psychological reasons for non-adherence, it’s probable that psychology-based interventions should be a regular part of optimized multi-component solutions.
However, fulfilling such a vision has practical implications. Specifically, to be effective psychology-based interventions will require time and new skills:
Time: There’s no ‘5-minute-fix’ for improving a patient’s beliefs, motivation, and self-efficacy. Quite the reverse, this will take appreciable time investments. For instance, time will be needed to engage with patients, build relationships, and gain their trust. Time will also be needed to understand their psychological status – their beliefs and what guides them, plus the ‘holes’ in their motivation or self-efficacy. Finally, time will be needed to modify beliefs and change patient behaviors; with better adherence as the overall goal.
New skills: In addition to baseline skills such as an open, friendly, and engaging discussion style, HCPs may also need to learn specific techniques. For example, motivational interviewing could be a valuable technique to master.
So who can take on this role – say within a physician practice?
Doctors can certainly do the job. But do they have the time? They already have so many other demands on their time; it’s probably not realistic for them to personally take on such new, time-invasive workloads.
What about Nurse Practitioners (NPs), or Physician Assistants (PAs), or Nurses? They can also do the job. Typically they enjoy spending time with patients; while nurses are also held in high esteem for honesty and trust. All of which are valuable assets for the role in question.
So maybe now is a great time for physicians to delegate these critical adherence-improvement tasks to their NPs, PAs, or nurses? Working together they can help achieve better adherence, better outcomes, and better overall quality.
What do you think?