A team of researchers from three universities claims that physicians can help patients follow prescribed treatments and achieve healthier resultsparticularly in chronic disease managementby using a three-pronged strategy it has developed.
The Information-Motivation-Strategy Model, developed after synthesizing findings from more than 100 large-scale studies and meta-analyses conducted between 1948 and 2009, appears in the peer-reviewed journal Health Psychology Review. It was developed jointly by researchers from the University of California, Riverside; Texas State University-San Marcos; and La Sierra University, in Riverside, Calif.
Nonadherence costs the U.S. health care system between $290 billion and $300 billion annually and wastes an estimated 275 million medical visits every year, study authors assert. The World Health Organization estimates that in developed countries, half of patients with chronic disease don't adhere to prescribed medication regimens, and the number is believed to be far worse in developing countries.
When regimens are more complex and intrusive, the authors write, patients are more prone to forget what they are supposed to do and are less likely to be able to carry out the directives that they do recall. Patients carry out prescribed regimens less effectively when they view their health problem as less severe, they add.
Nonadherence often is unrecognized by patients and their clinicians, according to UC Riverside's Robin DiMatteo, the study's lead author.
"Patients often misunderstand the value of following medical recommendations accurately, and physicians often overestimate patient adherence or cannot determine which patients are having adherence difficulties," DiMatteo says.
The model identifies three categories to guide providers and patients toward adherence: information, motivation, and strategy.
Information, and information comprehension, is instrumental to avoiding nonadherence. Many patients are incapable of understanding the health information they receive. The study recommends that clinicians communicate information effectively to patients, build trust, and encourage patients to participate in decision-making and to be partners in their own health care. It also recommends that they ask patients to share why and how they will carry out their treatment recommendations, listen to patients' concerns, and give them full attention.
Motivation is key, study authors say, because patients only follow treatments they believe in. Motivating patients to follow treatment recommendations is important. The study recommends that physicians help patients to believe in the efficacy of the treatment.
They also should elicit, listen to, and discuss any negative attitudes toward treatment, it says, and determine the role of the patient's social system in supporting or contradicting elements of the regimen.
Additionally, physicians should help the patient commit to adherence and to believe that they are capable of doing it, it says, and they should be sensitive to patient's cultural beliefs and practices, and view treatment through a cultural lens to make sure that recommendations don't conflict with cultural norms.
Finally, patients need a strategy to overcome common obstacles to adherence, such as the cost of medications, unreliable transportation to make appointments, mental health issues, and complex treatment regimens. Patients need a workable strategy to follow treatment recommendations.
The study recommends that caregivers help patients overcome practical barriers that make it difficult to carry out effectively a course of action.
They should identify individuals who can provide concrete assistance, identify resources to provide financial aid or discounts, provide written instructions and reminders, and offer links to support groups, it says.
The IMS Model emphasizes the importance of patient-practitioner relationships for effectively informing, motivating, and strategizing with patients.
It also is a useful tool for targeting patient needs, focusing on elements that are essential to achieving individual patient adherence, and ultimately optimizing health outcomes, the researchers say.
Subscribe today to our free E-Newsletters!SUBSCRIBE