Patient-Centered Communication to Assess and Enhance Patient Adherence to Glaucoma Medication

Topic: Using an understanding of a patient's difficulty in revealing nonadherence and patient-centered communication skills to identify and address barriers to adherence to glaucoma medication regimens. Clinical Relevance: In addition to cost and logistical difficulties with obtaining and administering medicine, a patient's adherence to medication is influenced by the balance between the perceived need for medication and concerns about taking medication. Methods: This article is based on both the author's clinical experience and peer-reviewed research on effective doctor-patient communication and assessment and management of nonadherence. Results: Three strategies have been identified that help physicians to detect and address problems with adherence: (1) a 4-step adherence assessment interview designed to detect nonadherence that decreases patient resistance to revealing nonadherence by applying a shared decision-making process and mitigating social undesirability; (2) asking open-ended questions in ask-tell-ask sequences; and (3) tailoring interventions to the patient's stage of readiness for change. Conclusions: Patients conceal nonadherence because they want to be thought of by their physicians as good patients. They are driven to nonadherence by an imbalance between their perceived need for medication and their concerns about taking it. Patient-centered communication techniques can engage the patient in shared decision making about medication, thereby redefining the good patient as someone who works with his or her health care provider to address adherence barriers. Those barriers can be explored with open-ended questions designed to elicit the patient's understanding and concerns, to provide information, and to assess change in the patient's understanding and attitudes. Communication will be more effective if it is based on the patient's stage of readiness to adopt adherent self-management practices. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. Ophthalmology 2009; 116:S37-S42 (C) 2009 by the American Academy of Ophthalmology.