A 45-year-old woman comes to the office for follow-up of type 2 diabetes mellitus. Current glycated hemoglobin level is 9%. The patient was diagnosed with diabetes a few months ago and was started on metformin twice daily. When the physician asks how she is doing with her medication, she replies, "I use it most of the time, but it's easy to forget when I am feeling good." Which of the following statements is most appropriate to begin a discussion about this patient's nonadherence to her medication?

Question

A 45-year-old woman comes to the office for follow-up of type 2 diabetes mellitus.  Current glycated hemoglobin level is 9%.  The patient was diagnosed with diabetes a few months ago and was started on metformin twice daily.  When the physician asks how she is doing with her medication, she replies, "I use it most of the time, but it's easy to forget when I am feeling good."  Which of the following statements is most appropriate to begin a discussion about this patient's nonadherence to her medication?

Quizplus · Accepted Answer

This patient with diabetes has suboptimal control of her blood glucose levels as evidenced by her elevated glycosylated hemoglobin level (HbA1c). She may also have limited understanding of her disease and the potential complications of poor glycemic control (believing that she can skip medication when she feels good). Medication nonadherence is more likely to occur when detrimental effects of missed doses are not immediately apparent, as in this situation. The best initial approach to medication nonadherence is to acknowledge the difficulty of taking a medication daily. Validating this patient's experience, rather than immediately judging her behavior, is more likely to facilitate an open discussion of her understanding of the illness and the factors contributing to nonadherence. Addressing possible misunderstandings about treatment in a nonjudgmental manner is crucial to promote medication adherence and strengthen the therapeutic alliance. (Choices A and E) These statements are condescending and judgmental in tone. Physicians should avoid criticizing the patient's behavior or assuming a lack of knowledge. (Choice B) This statement gives the patient a directive without first exploring her perspective and understanding of the illness. The best initial approach is to engage the patient with a statement that validates her experience and encourages open discussion of her challenges with medication adherence. (Choice D) It would be inappropriate to initiate a discussion on nonadherence by warning the patient about dangerous complications. Education about the illness and the importance of adherence should be done in a supportive and nonthreatening manner. Educational objective: Physicians should use a nonjudgmental, patient-centered approach in discussing treatment nonadherence. Acknowledging the difficulty of taking medication regularly can strengthen the therapeutic alliance, potentially improving patient receptiveness to educational efforts. __________ References: Health communication, self-care, and treatment satisfaction among low-income diabetes patients in a public health setting. (http://www.ncbi.nlm.nih.gov/pubmed/25468393) Patient-provider communication: understanding diabetes management among adult females. (http://www.ncbi.nlm.nih.gov/pubmed/19157762)

A 45-Year-Old Woman Comes to the Office for Follow-Up of Type