Kelly B. Haskard-Zolnierek

Improving patient adherence: a three-factor model to guide practice

Abstract Patient nonadherence is widespread and costly. This paper provides a brief narrative review of research on (non)adherence and validates a clinically useful three-factor heuristic model to guide practitioners as they work with patients to improve adherence. This model is based on the most stable findings from meta-analyses and large-scale empirical studies, reflects the realities of medical practice and offers recommendations for assessing and enhancing patient adherence, particularly in chronic disease management. The model comprises three important clinical actions: (1) insuring that patients have the right information and know how to adhere – including listening to patients’ concerns, encouraging their participation and partnership in decision-making, building trust and empathy, and enhancing recall; (2) helping patients believe in their treatment and become motivated to commit to it – that is, addressing the cognitive, social, cultural normative and contextual factors that affect patients’ beliefs, attitudes and motivation; and (3) assisting patients to overcome practical barriers to treatment adherence and develop a workable strategy for long-term disease management – including assessing and enhancing patients’ social support, identifying and treating their depression and helping patients overcome cost-related treatment barriers.

White coat hypertension: improving the patient-health care practitioner relationship.

White coat hypertension is characterized by the variability of a patient’s blood pressure measurements between the physician’s office and the patient’s home environment. A patient with white coat hypertension has high blood pressure levels in the physician’s office and normal blood pressure levels in their typical environment. This condition is likely caused by the patient’s anxiety within the physician’s office and in the presence of the physician. Research has shown that improving the relationship between a patient and their health care provider can decrease the patient’s anxiety, with the implication of decreasing the patient’s likelihood of demonstrating white coat hypertension. This review provides an overview of the previous literature regarding white coat hypertension, its prevalence, and the consequences for those who develop persistent hypertension. Furthermore, this review discusses the implications of improving patient and health care provider interactions through effective communication, empathy, and trust, as well as the implications for future research studies in improving the patient and health care provider’s relationship.

Serious Psychological Distress and Diabetes Care among California Adults

Objective: To evaluate three aspects of diabetes care (foot checks, eye examinations, and hemoglobin AlC checks by a physician) among California adults with Type 2 diabetes and serious psychological distress (SPD). Method: Data were from the population-based 2005 California Health Interview Survey. Estimates were that in 2005, 1,516,171 Californians (5.75% of all adults) had a physician-given diabetes diagnosis, and of those, 108,621 (7.16%) had co-morbid SPD. Results: Among Californians with Type 2 diabetes, SPD was associated with fewer physician foot checks (odds ratio = 0.56, 95% Confidence Interval = 0.32 to 0.97) but not with fewer eye examinations or hemoglobin AlC checks. Conclusions: The findings highlight a specific area—foot complication evaluation and prevention—for improving the quality of diabetes care among adult Californians with Type 2 diabetes and SPD.