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Communication to Promote Therapeutic Adherence. Ellen R. Cohn PhD University of Pittsburgh

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communication to promote therapeutic adherence

Communication to Promote Therapeutic Adherence

Ellen R. Cohn PhD

University of Pittsburgh

Ellen Cohn PhD is Director of Instructional Development at the University of Pittsburgh School of Health and Rehabilitation Sciences. She also has a secondary appointment in the School of Pharmacy, where she teaches healthcare and pharmacy-based communication.

first a quiz
First, A Quiz…
  • T-F Better educated patients are more compliant.
  • T-F Patients of introverted (vs. extroverted) pharmacists show more compliance.
  • T-F Telling a patient about potential side effects increases the likelihood they will occur.
  • T-F Pharmacist-patient interaction increases compliance.
the answers
…the Answers
  • True- Better educated patients are more compliant.
  • True- Patients of introverted (vs. extroverted) pharmacists show more compliance.
  • False-Telling a patient about potential side effects increases the likelihood they will occur.
  • True- Pharmacist-patient interaction increases compliance.
purpose and audience
Purpose and Audience

The purpose of this presentation is to:

  • Enhance the reader’s understanding of non-adherence, and
  • Present communication strategies to promote patients’ compliance to therapeutic regimens.

While the lecture was written for pharmacy students, the content may also be useful for other healthcare providers

non compliance an ancient view
Non-Compliance: An Ancient View
  • “Keep watch also on the fault of patients which often makes them lie about taking things prescribed.” Hippocrates
  • The patient must be monitored by their doctor
compliance a more recent definition
Compliance: A More Recent Definition
  • “The extent to which a person’s behavior (in terms of taking medications, following diets, or executing life style changes”) coincides with medical or health advice.” Sackett and Snow, 1979
compliance it s a medical construct
Compliance: It’s A Medical Construct
  • The patient must follow the physician’s orders
  • This construct implies it’s always wise to follow the health care provider’s advice
  • A more recent approach is to consider patient behavior in terms of adherence
adherence it s a complex construct
Adherence—It’s A Complex Construct!


  • The Person (patient)
  • The Medication
  • Spouse/Family/Peers
  • The Person-Healthcare Professional Relationship
adherence suggests a person centered approach
Adherence: Suggests A “Person Centered” Approach
  • Encourages self-regulation
  • Recognizes that non-adherence is sometimes logical and warranted
  • Person joins with the pharmacist to get the most benefit from the medication
  • The professional has “unconditional positive regard” for the patient
  • There is mutual trust and respect
adherence is not consistently related to
Adherence Is Not Consistently Related To:
  • Social class
  • Age
  • Gender
  • Education
  • Marital status
  • Intelligence
  • Memory
  • Personality disorders

We will consider five possible contributors to non-adherence:

  • Patient testing
  • Health beliefs
  • Poor communication
  • Cognitive factors
causes of non adherence patient testing
Causes of Non-Adherence: Patient Testing
  • Patients weigh costs vs. benefits of Rx
    • Address these before non-adherence occurs
  • Ask the person: do you think there will be any problems with the medication?
    • Provide information
    • Provide strategies
causes of non adherence health beliefs
Causes of Non-Adherence: Health Beliefs
  • Person’s perceptions of
    • Seriousness of illness
    • Outcomes of non-treatment
  • Perceived ineffectiveness of tx
  • Lack of social support
  • Social discouragement
  • Adverse effects
  • Lengthy/complicated tx
causes of non adherence poor communication
Causes of Non-Adherence:Poor Communication
  • Minimal medical supervision
  • Insufficient instruction
  • Poor feedback
  • Interactions with health professional
    • Perceived as unfriendly
    • Perceived as unconcerned
    • Little interaction
    • Unilateral interaction
unethical communication decreases adherence
Unethical CommunicationDecreases Adherence
  • Ethical communication empowers persons to make informed choices
    • The cruelest lies are often told in silence.” Robert Lewis Stevenson
ethical communication
Ethical Communication
  • Helps person recognize their situation
  • Helps person become aware of resources and their relevance
  • Helps person achieve motivation and reduce anxiety
  • Promotes a warm, caring environment within a professional relationship