Non-adherence

About 89 percent of people who come to doctors’ offices have already Googled their symptoms, notes D. Scott Covington, MD, FACS, CWSP. He says most patients wanted to see how serious their health condition was before going to an actual doctor. “They’re armed with misinformation. They’re really on the wrong path,” Dr. Covington told the audience at his presentation at the Symposium on Advanced Wound Care (SAWC) Fall.

Dealing with patients who can’t or won’t participate in their care can be a challenge for health care providers across all settings. In wound care, this lack of participation can result in great financial costs, diminished quality of life, and suboptimal clinical outcomes. This is part 2 of a 2-part series on noncompliance in wound care patients. Part 1 addressed possible reasons for noncompliance. In part 2, strategies to address these issues and increase patient participation are discussed. Part 1 of this blog discussed factors that impact a patient’s ability to adhere to clinician recommendations for care. Consequently, the most appropriate term to use when dealing with patients facing these obstacles is nonadherence. This term tends to be less value laden and more objective than noncompliance. Some of the reasons for nonadherence are voluntary and some are involuntary, or beyond the patient’s control. To review briefly, these reasons may include gaps in knowledge about the implications or severity of a chronic wound, limited recommendations or education by clinicians, perceived disadvantages to treatment, psychological factors, cultural factors, and social or financial constraints. Additionally, in some cases, alcohol or drug dependence can impact the patient’s ability to participate fully in their care.

An important step in wound management is identifying wound etiology. Pinpointing the problem often helps guide patient treatment. Identifying the cause of the wound, employing evidence-based interventions, and initiating an appropriate topical therapy will help to stabilize and, oftentimes, heal the wound. However, the decisions patients make on a daily basis, along with activities (time spent in bed, chair, with legs dependent, etc), have a significant impact on healing outcomes, independent of the wound care professional. Patient-centered education is a huge piece of effective self-management and an essential component of the nursing plan of care. This blog will focus on the importance of initial and ongoing patient-centered education in chronic wound management.