Three Ways to Improve Patient Follow Through
By Brittainy Wierzbicki, OT
One of the hardest things about being an Occupational Therapist (OT) is getting our patients to follow through with our recommendations. This includes home exercise programs, adaptive equipment recommendations, adaptive equipment recommendations, and anything else we ask our patients to do. It doesn’t matter how awesome our interventions are or how well we know how to improve a person’s function. If your client won’t follow through when you’re not around, then their progress will be limited. So take a look at the following recommendations and try them out next time you have trouble getting a patient to follow through with your recommended plan of care.
- Don’t assume that your patient understands what you said/wrote. As health care practitioners, we are educated and knowledgeable. We know how to use fancy medical terminology to sound smart, and we know what happens when people don’t take care of themselves. We understand why exactly high blood pressure is bad. We know why holding onto towel bars for stability is a recipe for disaster. But just because we know doesn’t mean our patients do. Hopefully we’ve all heard the term “health literacy”. Health literacy is “the ability to read, understand, and act on health information” (Eaton, 2004). According to the American Occupational Therapy Association, as OTs, we should “provide health education that is understandable, accessible, and usable by consumers” (Barnekow-Pizur & Darragh, 2011). In fact, nearly half of all adults have inadequate health literacy, meaning that they cannot appropriately interpret health care information (Vanderhoff, 2003). What should we do? Provide home exercises in both written and picture form. Use plain language: instead of saying “shoulder flexion”, say “raise your arms up overhead”. Even better, use their wording. If your client knows what “arm raises” or “toe touches” are, then write that. When using the teachback method to check your patient’s comprehension, avoid asking “do you understand”?, as this can elicit embarrassment or anger if the patient is confused. Instead, say something like “I’m really bad at explaining things. Why don’t you show it to me so that I can see if I did okay?” This way, if your patient doesn’t understand your instructions, you’ve placed the blame on yourself, inviting them to request further explanation.
- Make sure your goals are their goals. We’ve all done it. You spend a few therapy visits working to improve a person’s independence in dressing (bathing, meal prep, etc) without much progress or follow through, only to find out that your patient doesn’t really care if they can dress themselves. It seems important to us. Why would anyone not want to dress themselves? Maybe because they live with an adult child who dresses their aging parent as an act of love and respect. And maybe that adult caregiver would prefer you focus your therapeutic efforts on improving their parent’s bed mobility in order to give the caregiver’s aching back a rest. Whatever the reason, we have to be sure we’re all on the same page. Our clients and caregivers are much more likely to do their exercises or purchase the recommended adaptive equipment if it helps them achieve their goals.
- Give it meaning. Your clients need to understand how your specific interventions will help them reach their goals. For example, when I see someone who is having difficulty with upper body dressing I always look at their shoulder internal rotation, which is frequently limited. Home exercise program time! But telling a person to lean forward in their chair and try to touch the back of their belt, then repeat 10 times, twice a day, may seem silly to them. So be sure you explain that it will help make putting on jackets and button down shirts easier for them. Our clients will be more willing to complete their home exercises if they understand that those exercises were chosen specifically to meet their needs, rather than just “busy work”.
Barnekow-Pizur, K., & Darragh, A. (2011). AOTA’s societal statement on health literacy. The American Journal of Occupational Therapy,65(6), S78-S79. doi: 10.5014/ajot.2011.65S78
Eaton, J. A. (2004). Low health literacy seen impacting costs, compliance, outcomes. Physicians Financial News, 22(1), 1.
Vanderhoff, M. (2003). Patient education and health literacy. PT: Magazine of physical therapy, 13(9), 42-46.