Quality Standards for Diabetes Care Toolkit

Implementation advice

Medication management

Coulter et al (2008) conclude that encouraging patients to play an active role in their health care should address health literacy, shared decision-making and self-management. Interventions to promote these include:

written information that supplements clinical consultations

web sites and other electronic information sources

personalised computer-based information and virtual support

training for health professionals in communication skills

coaching and question prompts for patients

decision aids for patients

self-management education programmes.

NICE (2009) suggestions for encouraging medication adherence require:

a frank and open approach which recognises that non adherence may be the norm (or is at least very common) and takes a no blame approach, encouraging patients to discuss non adherence and any doubts or concerns they have about treatment

a patient centred approach that encourages informed adherence

identification of specific perceptual and practical barriers to adherence for each individual, both at the time of prescribing and during regular review, because perceptions, practical problems and adherence may change over time.

The World Health Organization (WHO 2003) concludes that the most effective interventions for enhancing adherence aim to improve self-management capabilities. Self-management programmes (see Standard 1) can improve health status and reduce health care utilisation and costs, and are critical for those with long term conditions as they must rely on effort and self-regulation to maintain behaviour. The strategies suggested to be effective include:

self-monitoring

goal-setting

stimulus control

behavioural rehearsal

corrective feedback

behavioural contracting

commitment enhancement

creating social support

reinforcement

relapse prevention.
Such strategies are most effective when delivered as part of multimodal programmes and tailored to the individual to include the creation of social support, reorganisation of the service delivery environment, increased accessibility of services and delivered within a collaborative treatment relationship.