Why Patients Are Non-Compliant
Laura Friedhoff, MSW, LISW, a social worker at Cincinnati Children’s Hospital, says social workers can assist doctors in determining why patients may not be taking their medications as prescribed. Non-adherence has been shown to lead to poor outcomes.
“We’re able to dig a little deeper into adherence issues,” Ms. Friedhoff says. “We may learn that a child’s father lost his job and they don’t have insurance to pay for the meds, or that a young patient may be terrified of needles or doesn’t like swallowing pills.”
After issues have been identified, Ms. Friedhoff says social workers can connect families to the appropriate resources, whether that’s securing Medicaid to cover costs or referring them to a clinical psychologist if a patient has fears about their condition.
How to Cope with Psychosocial Factors
Social workers also play a valuable role in helping patients come to terms with the anxiety and depression that often accompanies a chronic rheumatic condition.
Gregory Taylor, MSW, RCSW, of the Young Adults with Rheumatic Disease Clinic for the Mary Pack Arthritis Program, Vancouver Coastal Health, British Columbia, Canada, works with patients who are transitioning to adult care.
“We often see patients who are emotionally adjusting to having a chronic illness,” Mr. Taylor says. “Their perceptions may generate low self-esteem or depression that, in turn, affect their ability to keep medical appointments or adhere to medication.”
Mr. Taylor says these are two examples of basic arthritis self-management behaviors that require skill development. Nearly all outcomes are mediated through the patient’s behavior—that is, what the patient does to cope better.
Because patients with rheumatic disease aren’t routinely screened for depression, Mr. Taylor says it’s important for rheumatology patients to have their motivation, skills and confidence in managing their health condition regularly assessed for progress by social workers.
“We must realize that a rheumatology visit involves a minuscule amount of time in a patient’s life,” Mr. Taylor says. “At our clinic, young adult patients are assessed every three to four months, because it takes time to teach a patient the skills to self-identify problems of living with a chronic illness and how to use a process to solve these problems.”
Mr. Taylor says patients are also referred to a social worker if a doctor or clinic nurse senses the patient has anxiety, psychosocial issues or even a loss of purpose.
“By having the time to meet with the patient regularly and develop trusted relationships, we are in a good position to assist a patient in taking greater responsibility for their health by learning self-management support strategies to improve quality of life,” he says.