文章基本信息

标题：Turning Patients into Self-Managers
期刊名称：Health Progress
印刷版ISSN：0882-1577
电子版ISSN：1943-3417
出版年度：1998
卷号：May/Jun 1998
出版社：Catholic Health Association of the United States

Turning Patients into Self-Managers

Everyone knows that a spoonful of sugar helps the medicine go down-but sometimes it takes more than that to get patients to take their medicine, or make necessary lifestyle changes. Research has shown that nearly half of patients do not fully comply with doctors, orders; up to 20 percent of all prescriptions remain unfilled and, of those that are filled, as many as 50 percent are taken inconsistently or not at all. Marcia Ringel, writing in Business and Health, describes approaches doctors take to encourage patients to follow their healthcare regimens.

Patients diagnosed with chronic illnesses such as diabetes or hypertension may feel overvhelmed by the lifestyle changes they are suddenly advised to make, as well as the diagnosis itself. In such cases, recognizing that the willingness to make changes is an ongoing process, rather than the work of an instant, can be helpful. Physicians should tailor their message and expectations to meet patients at their level of readiness for change.

Motivation also depends on understanding, and the more clearly a patient grasps the rationale behind recommended treatment, the more likely he or she is to comply. Teaching patients to be involved observersto monitor their own blood pressure, for instance-can help overcome feelings of helplessness and improve compliance. Nurses and pharmacists can also play a large part in supporting the patient and explaining procedures and medications.

Healthcare providers should try to pinpoint the source of the patient's behavior. Some patients may resist what they see as an authoritarian manner; others may simply be concerned about the cost of prescriptions. Enlisting family help is effective, as is continued follow-up.

At Stanford University, research on the "biology of self-confidence" has yielded interesting results. In interventional programs, patients are taught how to deal with problems in their daily lives caused by their disease and formulate weekly action plans, whose goals may be as simple as visiting a friend. As they gain confidence and a sense of self-efficacy, they feel that they can exert some control over conditions that influence their lives, and then they become better self-managers.