So, so much for keeping up to date.
RSA; A matter of life.
I’ve had a few weeks looking into the issues and problems around patient non-adherence. Reading lots of medical reports, journals and speaking to a few lovely people whose experience around the matter has helped quite a bit. Fairly early on I discovered that one of the most susceptible groups to non-adherence as those under the age of five. This fairly stopped me in my tracks.
I’ve been scoping out the relationships and experiences between Healthcare professional, parent/carer and patient – looking at where the trust lies, who takes responsibility at certain times, how much involvement the child has in both consultation/diagnosis and administration of the meds. It can get really quite complicated, each relationship can differ depending on so many factors. Reading the online blogs of parents on the NHS Choices website has helped to guide me into the parent’s way of thinking. How their knowledge, understanding and memories regarding the consultation and advice given can be clouded by sheer anxiety and stress.
One thought that keeps popping into my head is that these parents need a certified, reliable source of information that they can refer to after the consultation – complicated regimes and multiple medicines can be difficult to take in, no matter your state of mind. If this information came with the NHS brand it would install an element of trust, and if it were used to research symptoms before a consultation the doctor would also trust it. (GP spend an awful lot of time re-interpreting dodgy material that has been found by patient or parents on the internet.)
Surly this information would need to be monitored, filtered and kept up to date? How would this work?
What media would it be – parents may want to access information through Leaflets, Online Forums, Telephone Help lines, Support Groups, Websites, Blogs, Talking to other Parents … what else could be explored…?
I’ve also ben thinking a lot about Health Literacy – apparently a bit of a buzz word at the moment. It deals with not only an individual’s ability to comprehend written information, but specifically to be able to analyse and act on medical terms and instructions. The labelling of medicines is an issue I am currently really interested in,and I believe I will follow through in this project. I’m looking at how the individual Pharmacies decide on the design and layout of their labels – font, type sizes, space for self-marketing, useful information, unnecessary information and the all important instructions and dosages. Research states that ‘Take two in the morning, and two in the afternoon’ is more likely to be adhered than ‘Take two twice daily’. Yes it is a longer command, but it gives the patient or parent more to work with, essentially. They need to be able to put the new routine into perspective, apply it to their lives to see how it will fit.
Non-adherence in the under 5s is particularly interesting as the patient in this case is never responsible for the administration of their medication. I want to look at their involvement throughout the process, from initial symptoms, the decision to go to the doctors, the discussion during the consultation, diagnosis and prescription, discussion with the Pharmacist and finally what happens once at home again – without a medical professional to take responsibility and advise. I’m going to speak to a local Pharmacist on Saturday,who has experience in the realms of childhood medicines and illnesses, her brains will be picked!
Another big part of the project, certainly the research stage, involves education. Of the parent, about their child’s condition – to encourage self-reliance and empowerment, allowing for greater involvement, remembrance and willingness to proceed with the treatment plan. Of the healthcare professional, to be able to read their patients and parents. A treatment plan may be a bad decision if it is only going to be administered poorly or not at all, so perhaps no action would be better. The relationship needs to build. Of the patient, allowing them a better understanding of what is going on around them,the decisions being made and what will happen next, answers to questions ‘why am I feeling like this?’ Involvement and a sense of responsibility, even if it is only a placebo.
It’s all a bit higgletypigglety, I plan on getting my thoughts straightened out and directed pretty sharpish. But I’m keen to explore all my thoughts at least a little before I move on to making those quick sketches and squiggles into something that might just work … you never know what’s under those stones.
Pictures to follow…