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Exploratory study of language paediatricians use to promote adherence to long-term controller medication in children
Tom Koole1, A Debbie C Jaarsm2, Paul L P Brand3
1University of Groningen, the Netherlands; School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa.
Insights
Pediatricians can improve medication adherence in children with asthma by starting consultations with the patient's agenda, answering questions, and seeking explicit agreement on treatment plans. This patient-centered communication fosters better adherence.
Area of Science:
- Pediatric Pulmonology
- Health Communication
- Patient Adherence Research
Background:
- Patient-centered communication is linked to improved medication adherence.
- Specific communication strategies that enhance treatment adherence in pediatric chronic asthma remain unclear.
Purpose of the Study:
- To explore the language and communication techniques used by pediatricians to promote adherence to daily controller medication in children with chronic asthma.
- To identify communication phenomena associated with high treatment adherence in pediatric asthma management.
Main Methods:
- Conversation analysis of videotaped follow-up consultations.
- Study involved seven outpatients (4-13 years) with chronic asthma and their caregivers.
- Consultations were with two pediatric respiratory physicians in a practice known for high treatment adherence.
Main Results:
- Starting consultations with the patient's agenda facilitated the introduction of new issues.
- Information provision was primarily reactive to patient/caregiver questions, allowing for tailored advice.
- Patients/caregivers resisted unsolicited information but accepted explicit requests for treatment agreement.
- Positive treatment outcome descriptions encouraged acceptance of proposed therapies.
Conclusions:
- Effective pediatricians initiate consultations by addressing the patient's agenda.
- They provide information in response to queries and offer reassurance.
- Seeking explicit agreement on treatment plans is a key strategy for enhancing adherence.
Introduction And Objectives:
Although patient centred communication is associated with patients' daily medication adherence, the exact communication phenomena promoting high treatment adherence remain elusive.
Patients And Methods:
We used conversation analysis of videotaped follow-up consultations of seven outpatients (4-13 years of age) with chronic asthma and their caregivers, consulting two paediatric respiratory physicians in a practice in which high treatment adherence has been documented, to explore the language paediatricians use to promote their patients' adherence to daily controller medication.
Results:
Starting the consultation with the patient's (and caregivers') agenda commonly resulted in presentation of issues new to the physician. Information was mostly provided in response to patient/caregiver questions, prompting the delivery of specific information tailored to the patient's and caregivers' needs. Although patients and caregivers showed resistance in response to unsolicited information and advice, they always accepted the doctor's explicit request for agreement with proposed treatment. The doctor's description of favourable treatment results in most patients prompted caregivers' willingness to accept treatment proposals.
Conclusions:
Paediatricians with a documented success in achieving adherence to controller medication in their patients with asthma tend to start consultations with the patient's agenda, provide information in response to questions, offer reassurance on overall treatment effectiveness, and seek explicit agreement with a treatment proposal.
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