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Empowering Patients – Recognising the Skills. Amanda J. Monsell Advanced Practitioner: North Cardiff Medical Centre Associate Lecturer: Non-medical Independent Prescribing Cardiff University Contact details: MonsellA@cardiff.ac.uk. Learning Outcomes.

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empowering patients recognising the skills

Empowering Patients – Recognising the Skills

Amanda J. Monsell

Advanced Practitioner: North Cardiff Medical Centre

Associate Lecturer: Non-medical Independent Prescribing

Cardiff University

Contact details: MonsellA@cardiff.ac.uk

learning outcomes
Learning Outcomes
  • To be familiar with the key principle of concordance in non-medical independent prescribing.
  • To recognise the barriers to information-giving within a consultation
  • To highlight availability of patient decision making tools
empowerment
Empowerment

Patient empowerment is considered a paramount skill in the prescribing arena

It can be defined as:

1. “To give power or authority to – to authorize”

2. “To give ability to; enable or permit”

Sinclair et al 1999 pp. 468

empowerment and prescribing
Empowerment and Prescribing
  • Communication
  • Patient participation
  • Awareness of patients concerns
  • Shared-decision making
  • Concordance
  • Acceptance that sometimes the patient may want to decline treatment
communication
Communication
  • Good communication and patient participation is the crux of the shared decision-making process1;2but how is this best achieved?
  • One needs to consider several factors
    • Patient’s capacity to retain and recollect information
    • Their understanding and assimilation of that information
    • The impact of consultation time on what are potentially life-long decisions
capacity
Capacity
  • Memory for recollection of information is poor and worsened by anxiety and age1
  • Ability to remember information is small
    • 40-80% of information given in a consultation is forgotten immediately 2
  • The more information given, the more is actually forgotten2
understanding
Understanding
  • To achieve patient understanding and true concordance requires time and the formation of a partnership between the clinician and the patient.3
  • Equipoise is advocated from the clinician demonstrating no set opinion4
  • This is highlighted as essential especially with the increase in poly-pharmacy2
  • Consideration must be given as to how understanding can be best achieved
time implications
Time Implications
  • Within a consultation there must be recognition that the patient may need time to reflect upon the information given after all 10-15 minutes isn’t long!
  • Allowing a patient to go home and discuss the options with family and friends can help the process of informed decision making6
  • Having easy access to patient information leaflets assists the process7
barriers to adherence
Barriers to Adherence
  • Anxiety
  • Poor relationship and using “medic speak”8
  • Depression (use of PHQ-2 assessment for patients with chronic diseases in primary care)9
  • Dictatorial or paternalistic approach to the consultation in some instances
  • Age and Gender10
decision making aids
Decision-making Aids
  • Media releases
  • Internet
  • Patient Information leaflets7; 11; 12
    • Written
    • Pictorial11,12
  • Videos / DVD13
  • Verbal advice7; 14
    • Expert patient groups
patient participation
Patient Participation
  • How do we get patient’ “involved”?
    • Respect the patient’s opinion
    • Discuss their concerns
    • Continuity of care
    • Assess a patient’s literacy skills
    • Work as a team
empowerment1
Empowerment
  • Communication
  • Truthfulness
  • Back up verbal information with written leaflets
  • Build the relationship with the patient
  • Plan review appointment but allow open door access if problems arise
references
References
  • NICE (2009). Medicines adherence. Involving patients in decision about prescribed medicines and supporting adherence. NICE Clinical Guideline 76. London, National Institute for Health and Clinical Excellence.
  • Clyne, W., Granby, T., Picton, C. (2007). A competency framework for shared decision-making with patients: Achieving concordance for taking medicines. Retrieved from [last accessed 02/08/2011]
  • Hook, M. L. (2006) Partnering with patients – a concept ready for action Journal of Advanced Nursing56(2) pp. 133-143.
  • Kessels, R. P. C. (2003). “Patients’ memory for medical information.” J R Soc Med96(5): pp. 219-222.
  • McGuire, L. C. (1996). “Remembering what the doctor said: organization and adults’ memory for medical information.” Exp Aging Res 22(4): pp. 403-428.
  • Elwyn, G., Edwards, A. and Britten, N. (2003). ““Doing prescribing”: how doctors can be more effective.” BMJ327(7419): pp. 864-867.
references1
References
  • Coulter, A. and Ellins, J. (2007). “Effectiveness of strategies for informing, educating and involving patients.” BMJ335(7609): pp.24-27.
  • LaRosa, J. H. and LaRosa, J. C. (2000) Enhancing drug compliance in lipid-lowering treatment. Arch Fam Med 9(10) pp. 1169-1175
  • Li, C., Friedman, B., Conwell, Y. and Fiscella, K. (2007) Validity of the Patient Health Questionnaire 2 (PHQ-2) in identifying major depression in older people. J Am GeriatrSoc55(4) pp. 596-602
  • Carter, S. Taylor, D. and Levenson, R. (2005) A question of choice – compliance in medicine taking – a preliminary review (3rd ed.) [Accessed: 06.09.2009: http://www.keele.ac.uk/schools/pharm/npcplus/medicinespartner/documents/research-qoc-compliance.pdf
references2
References
  • Houts, P. S., Bachrach, R., Witmer, J. T., Tringali, C. A., Bucher, J. A. and Localio, R.A. (1998). “Using pictographs to enhance recall of spoken medical instructions.” Patient EducCouns35(2): pp. 83-88.
  • Edwards, A., Elwyn, G. and Mulley, A. (2002). “Explaining risks: turning numerical data into meaningful pictures.” BMJ 324(7341): pp. 827-30.
  • Barkhordar, A., Pollard, D. and Hobkirk, J. A. (2000) A comparison of written and multimedia material of informing patients about dental implants. Dent Update 27(2) pp. 80-84
  • Hege, A. C. G. and Dodson, C. S. (2004). “Why Distinctive Information Reduces False Memories: Evidence for Both Impoverished Relational-Encoding and Distinctiveness of Heuristic Accounts.” Journal of Experimental Psychology: Learning, Memory& Cognition 30(4): pp. 787-795.