Strategies for Adherence: A DBT Clinical Perspective
Key Points
- Medical interventions for non-compliance focus on education, coaching, case management, and technology.
- Change is relationship-based, both between the professional and the patient, and the individual and their experience.
- Find more effective short-, mid-, and long-term ways to meet clients’ needs and increase adherence.
- Understand clients have escape, avoid, and alter behaviors.
- Meet those behaviors with acceptance and build that into the plan.
- Explore those behaviors at the engagement point of the action plan to decrease challenges to adherence.
- Track outcomes through PCOMS, questionnaires, surveys, and interviews.
- Check-in consistently with clients about what’s working or not.
- Behavioral health interventions focus on agreed-upon plans that move towards adherence.
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Transcript
So let’s look at some reasons why individuals may not be adherent, why they may not follow advice, guidelines, or agreed-upon plans.
One of the first things is, let’s challenge some of the language where when we’re talking about adherence. That’s a little bit more neutral, engaged, partner-based, and has some positive connotations to it. The more adherent I am, the higher the probability of me increasing my functioning or increasing my quality of life.
Cutler, R. L., Fernandez-Llimos, F., Frommer, M., Benrimoj, C., & Garcia-Cardenas, V. (2018). Economic impact of medication non-adherence by disease groups: A systematic review. BMJ Open, 8, e016982.,Matthews, R. (2018). The value trap. Group Practice Journal, 67(10), 10-13.,Penso, J. (2018). Changing the course of chronic disease. Group Practice Journal, 67(10), 1-5.
The older language that can be helpful to challenge is that concept of, “Why aren't I following your advice?”. “Why am I not following what you’re telling me to do?” That can be really viewed as judgmental, if is that you’re not compliant. You're not doing what you're told to do. Therefore you're bad, inept, not engaged, not working with me, you're working against me. And it kind of creates two different teams: one that the professional or team is on, and then the client. We end up isolating them.
Cutler, R. L., Fernandez-Llimos, F., Frommer, M., Benrimoj, C., & Garcia-Cardenas, V. (2018). Economic impact of medication non-adherence by disease groups: A systematic review. BMJ Open, 8, e016982.,Matthews, R. (2018). The value trap. Group Practice Journal, 67(10), 10-13.,Penso, J. (2018). Changing the course of chronic disease. Group Practice Journal, 67(10), 1-5.