How The Doctor-Patient Partnership Affects Treatment Adherence
By: Christele Felix
Treatment adherence is crucial to getting better. I know from personal experience that when I deviate from my treatment plan (whether it's because of forgetfulness or carelessness), my health suffers. It’s essential for me, the patient, to do my part in managing my health. Ideally, it would go like this: the doctor uses his/her knowledge to diagnose and determine the best course of treatment, the patient takes said treatment. It often isn’t that simple though for a variety of reasons, like difficulty getting a diagnosis, then difficulty finding the correct treatment plan that works for that specific patient. Another issue that can arise once a treatment plan has been prescribed is adherence to treatment. Adherence (or compliance) means taking the treatment as told, on time, for the specified duration, and not missing a single dose. A 2006 study published in the Journal of American Medical Association concluded that that the average compliance for long-term treatment plans was only about 50%.
Patient knowledge - Low adherence can be caused by the patient not fully understanding the role of the medication in his/her treatment plan. The standard has usually been that the doctor would suggest a medicine, then write it down on a script and that would be it. Conversations about the role of the medication in laymen terms, and the importance of the dosage and timing of the medication to have the proper effect can help patients in staying faithful to their treatment plan. Some pharmacies have stepped in to provide patients with the literature on the use, dose, effects, etc, of the medications given to them.
Patient-doctor relationship - The relationship between the patient and the doctor prescribing the treatment, and the degree of trust the patient has in that doctor can also affect treatment adherence. The dynamic communication between patient and patient influences how the patient thinks and acts on his/her treatment plan outside of the doctor’s exam room. I have been very lucky to have a great relationship with my rheumatologist, and the trust I have in her motivates me to do my part in our partnership.
Patient involvement - The more involved the patient is in designing their treatment plan, the higher the rate of adherence because the patient is now an active part of their healthcare team. This again relates to the patient-doctor relationship. It has been standard for a long time, that patients were considered passive bystanders as doctors and others lead the healthcare team. We are finally in the day and age where we are beginning to recognize (although there is a lot more advancement needed) the role the patient can play, and that involving the patient only makes for a more efficient treatment outcome. This leads the patient to have more motivation to take the necessary steps to do his/her part.
Context in the patient’s life - Patients tend to not be fully adherent to treatment plans that are too complex or involve multiple doses a day. This is a bigger issue than people realize because for many therapies the optimal outcome depends on a strict and continuous following of a specific dosage. Another way treatment can be inconvenient to a patient’s life depends on the instructions for each medication, especially if the individual has multiple medications to take, as most of us do.
For example, prednisone is recommended to take with food, but Cellcept, which is usually part of the same treatment regimen, requires that you take it 2 hours before or 1 hour after a meal. This makes it difficult for the patient to fully adhere to all his or her medication. Treatment plans can also be an inconvenience depending on the lifestyle or diet changes they require. Conversations between doctor and patients that focus on the patient’s quality of life, goals, and interests outside of their disease can help determine the best way to fit a new treatment plan into a person's life.
My treatment adherence rate improved dramatically after my doctor let me try taking my prednisone in one dose instead of splitting it into 2. For other medications that require a lag time in between, we talked about my schedule to arrange a medicine schedule that works. If all else fails, I still have my phone alarm.
Other factors, forgetfulness - The final issue is simply forgetfulness, either because of Lupus brain fog or because sometimes as we feel better, we tend to forget that we still need our medication to remain healthier. Phone reminders and weekly pill cases can help to keep us on track. I also have a few trusted friends in my circle who occasionally send me gentle reminders. That support often helps me get around the fog and take better care of myself.
Communication is key! Patients that are properly educated on their treatment plan are more likely to be compliant with the instructions for their plan. Clear communication also ensures trust between the doctor and the patient and trust about the outcome of their treatment, all of which motivates the patient to stay on track with his or her plan. Consider having more conversations (time permitting) with your doctor, not just about Lupus and symptoms and prednisone, but also about your hobbies, your goals, and about that event you’d like to attend next weekend!