British Medical Journal, 2001 Compliance: Adherence to regime of care and persistence with it over time

Transcription

1 Coaching Patients to Optimal Interdental Health Presented by: Carol A. Jahn, RDH, MS, Senior Professional Relations Manager, Water Pik, Inc Disclosure Statement Water Pik, Inc: Designed and developed this course/manufactures and distributes products addressed in this course Provided an educational grant to support this course Carol A. Jahn, RDH, MS Is employed by Water Pik, Inc as the Senior Professional Relations Manager and serves on the board of the RDH Magazine, Access Industry Board, and the corporate council for Dimensions of Dental Hygiene Journal of Evidence-Based Practice, 2005 Involving patients in a decision process that accounts for risks and benefits of treatment, the seriousness of their condition, costs, and personal beliefs is associated with improved access, compliance and health outcomes. Evidence-based Clinical Practice: Concepts & Approaches, 2000 The ways in which choices are described, including the language chosen to describe possible outcomes, have a profound effect in framing such decisions and influencing which options are eventually chosen British Medical Journal, 2001 Compliance: Adherence to regime of care and persistence with it over time Merriam Webster Dictionary Compliance: Yielding to the wishes of other British Medical Journal, % of people with chronic disease comply with recommendations, irrespective of disease, treatment or age/poor even among patients with a high and moderate risk of death/inverse relationship between daily dosing and compliance/problems exist in all countries/compliance rate: 1x day: 78%, 2x day: 72%, 3x day: 64%, 4x day: 60% Archives of Internal Medicine, 2006 In people who have had a heart attack/1 in 8 (12.5%) stopped taking all meds by 1 month after hospital discharge/another 4% discontinued 2 drugs/18% had dropped at least one drug/risk factors included older age and low education level Health Behavior Change in a Dental Practice, Suvan, 2010 We tend to assume that patients are lacking and that if they just had more knowledge, insight, skills, or concern about their situation, they would make a change/people often underestimate their own risks and overestimate their skills/we think they expect us to give advice. So we repeatedly dispense more information and recommendations There are limits to what can achieved through advice along/the expression of empathy perhaps the most important factor in eliciting change Bringing out the best in your is the way to bring out the best in your patients. Identify your strengths with the strengths finder survey Health Behavior Change, 2000 Patients are not a homogenous group when it comes to behavior change ;depending on their degree of readiness to change, they have different needs and should be treated accordingly Prochaska et al, , Water Pik, Inc Page 1

2 In change, as in many other aspects of life, timing is everything. You will apply different processes to your problems at different stages of change. Stages of change: Precontemplation, contemplation, preparation, action, maintenance Precontemplation: I won t, resist change, come to an appointment through pressure, want people to quit nagging, have a feeling of hopeless ness Contemplation: I might, acknowledge problems, struggle to understand, explore solutions, make plans/but some are chronic contemplators Preparation: I will, high awareness, make adjustments, public intentions, committed but ambivalent Action: I am, commitment, time, energy, visible results, recognition, but action does not equal change Maintenance: I have, great challenge, struggling with relapses, commitment, need encouragement Health Behavior Change in a Dental Practice, Suvan, 2010 All patients have the potential for change: Key components: collaboration, evocation, autonomy Collaboration: working with the patient to foster a partnership; enhance joint decision making towards the goal Evocation: eliciting the motivation from within. Guiding the patient to examine ambivalence and evoke change Autonomy: Recognizing the freedom of patients to make their own choices/enhances internal motivation JADA, 2004, 2006: Children who received coaching via motivation interviewing had less decay 1 & 2 yrs later than those who received a traditional counseling approach Rollnick, 2008: Coaching initiatives by doctors, nurses, dieticians produced positive clinical outcomes in people dealing with weight, heart disease, alcohol consumption. Type of professional credential did not matter; all were successful Health Behavior Change, 2000 Coaching via motivational interviewing is founded on the principle of brief interventions of 5-15 minutes. Words matter: there is a powerful connection between the words we use and the results that we get Ambivalence is good: it is a natural way to feel about change, sets up the opportunity for change, allows for empathy Motivational Interviewing in Healthcare, 2008 R: resist the righting reflect/u: understand your patients/l: Listen to your patients/e: empower your patients Resist the righting urge: natural instinct/but leaves the person with the only alternative to resist/take up the other side Understand: It is the patient s own reason for change that needs to be the trigger/ ask them what they would consider Listen: we think patients expect us to have the answer but the answer lies within the patient Empower: outcomes are better when patients are interested and take an active role/help them explore options Health Behavior Change in a Dental Practice, Suvan, 2010 Styles of communicating: Directing/Following/Guiding Directing: traditional approach/necessary in some cases/works best with good rapport or by patient request Following: predominated by listening/used when sensitivity is needed/provides understanding and support Guiding: helps patients solve problems for themselves/identifies what s possible/good with ambivalence OARS: open questions/affirmations/reflective listening/summarizing Questions to consider: Does your patient want to talk?/may have more pressing life issues, no rapport or a precontemplator How do you ask questions? Do you ask permission? Can reinforce patient autonomy and build rapport Using open questions: How do you feel about flossing/what do you know about periodontal disease How do you provide support: recognizing efforts, encouragement, helping them believe they can do it Affirmations You are doing better with your blood sugar, congrats/you are using your water flosser 5x a week, that s great/you are thinking about quitting smoking, that s a great first step Reflective Listening: 2012, Water Pik, Inc Page 2

3 Allows the patient to feel understood/encourages clarification/gives the clinician space to process/ helps patients explore where they are and where they want to be/gives perspective Take into consideration what they already know/their interest in further info/perception of what the information means to them/otherwise we waste our time and theirs Summarizing: Instead of telling/reflect and summarize what was exchanged/demonstrates listening/understanding Dealing with discrepancies in behavior: develop a pro/con matrix. Start with the pros of not changing What worries you the most about your current situation/what do you think might happen if you don t change/what are the advantages of change/what success have you had in the past/what are you willing to try Rolling with resistance: sample responses to a Mom whose child goes to sleep with a bottle and has ECC and is reluctant to take the bottle way from her Simple reflection: So you are saying this isn t a good time? Amplified: So, you don t see any problems with this situation? Double sided: On one hand, it s easier to get her to bed with the bottle, on the other you realize it s bad for her teeth Agree with twist: Your right, taking the bottle away will be painful and so is tooth decay Emphasis on personal control: You re her mom, this is your choice; I won t nag. I do need to get a better understanding of what we can do to stop/control the decay Reframe: You re daughter likes the bottle, and I sense you are worried about the pain and expense of continued decay Readiness to change is dependent upon importance and confidence. Both can be enhanced Importance: related to values/goals/beliefs/priorities Confidence: perceived ability to cope with the change I remember you had some success with. Many of my patients tell me. This may not fit for you, and.. What has worked for some.. The research tells us.. To get or strengthen the commitment: What changes, if any, would you consider? It sounds like you don t want things to stay the same, what would you like to do? You sound pretty confident, what s your next step? Graves et al, J Periodontol, week trial with 119 adults comparing brushing & flossing to brushing alone/brushing & flossing was supervised Toothbrushing achieved a 35% reduction in bleeding /Brushing and flossing achieved a 67% reduction in bleeding sites International J of Dental Hygiene, 2008 Meta-analysis of 11 studies; minimum 28 days Four found better plaque removal with the addition of floss One found a greater reduction in bleeding with floss/the routine instruction of flossing is not supported by scientific evidence/the RDH should determine on an individual basis whether high quality flossing is an achievable goal J Dental Research, 2006 Flossing s effectiveness in reducing caries is dependent upon fluoride exposure and compliance There are no studies showing flossing prevents caries in adults in real-world conditions The dental professional should determine on an individual basis whether quality flossing is achievable One should be careful to justify flossing based on common-sense arguments when other caries prevention interventions are supported by higher levels of evidence. Canadian Dental Hygienists Association Position Paper on Flossing, 2006 Many flossing aids and interdental cleaners including floss holders, automated flossers, interdental brushes, picks, wooden sticks, and some home irrigators are viable alternatives to manual finger flossing 2012, Water Pik, Inc Page 3

4 Yankell et al, J Clin Dent, 2002 BrushPicks vs Glide Floss Similar reductions in plaque Greater reduction in Bl & GI for BrushPicks Lewis et al, J Periodontol, 2004 Toothpick holder vs floss: no significant differences for plaque, interproximal plaque or bleeding Christou et al, J Periodontol, 1998 Interdental brush reduced significantly more plaque than floss but similar in bleeding Kleber et al, J Dent Hyg, 1990 Floss holder vs traditional floss: Equally successful in removing plaque and reducing gingivitis Rosema et al, J Int Acad Periodontology, Jan 2011 The Water Flosser was twice as effective as floss at reducing gingival bleeding Sharma et al, Am J Ortho Dentofacial Orthop, 2008 The Water Flosser with the Orthodontic Tip was 3x as effective as floss in reducing plaque and 26% more effective at reducing bleeding Barnes et al, J Clin Dent, 2005 The Water Flosser with the Classic Jet Tip was up to 93% more effective at floss in reducing bleeding and up to 52% more effective at reducing gingivitis Compendium Cont Ed in Dent, March 2009 The pressure and pulsation combination of the Water flosser removed 99.9% of plaque biofilm in treated areas Daily use of a Water Flosser can significantly reduce the bacterial load and the risk for periodontal disease Sharma, 2012 The Water Flosser was 80% more effective at reducing gingivitis and 70% more effective at reducing plaque than the Air Floss Water Pik Resources: Dental Professional Customer Service: Patient Education Brochures and Orders click on explore Professional Instruction Manuals & Quick Start Guides/Educational video clips for patients & practitioners/research Summaries Complimentary Self-study Continuing Education Courses Water Flosser: An Evolutionary Step in Interdental Care/The Diabetes Epidemic: The Impact on Oral Healthcare Providers The New Challenges of Child and Adolescent Health Seniors & Boomers: Living Longer, Living Healthier Coaching Your Patients to Optimal Interdental Health Periodontal Therapy & Maintenance Like Us on Facebook/Waterpik Consumer Oral Health Newsletter:: Sign up on-line or by texting WATERPIK to Recommended Reading: Switch: How to Change Things When Change is Hard, 2010, Chip & Dan Heath Health Behavior Change in the Dental Practice, 2010, Ramseier & Suvan, Eds. Motivational Interviewing in Healthcare: Helping Patients Change Behavior. 2008, Rollnick, Miller, Butler, Eds Health Behavior Change: A Guide for Practitioners Rollnick, Mason, Butler, Eds 2012, Water Pik, Inc Page 4

5 References/Resources: 1. Ho PM et al. Impact of medication therapy discontinuation on mortality after myocardial infarction. Arch Intern Med 2006; 166: Bloom BS. Daily regimen and compliance with treatment. BMJ 2001; 323: Joffe H. Adherence to health messages: A social psychological perspective. Int Dent J 2000; 50: Rollnick S et al. Motivational interviewing in Health Care: Helping Patients Change Behavior. 2008; New York: Guilford Press. 5. Auerbach J. Personal and Executive Coaching Ventura, California: Executive College Press. 6. Rubak S et al. Motivational interviewing: A systematic review and meta-analysis. Br J Gen Pract 2005; 55: Weinstein P, Harrison R, Benton T. Motivating parents to prevent caries in young children: One year findings. J Am Dent Asso 2004; 135: Weinstein P, Harrison R, Benton T. Motivating mother to prevent caries. Confirming the beneficial effect of counseling. J Am Dent Assoc 2006; 137: Rollnick S et al. Health Behavior Change: A Guide for Practitioners Edinburgh: Churchhill Livingstone. 10. Prochaska O et al. Changing for Good. A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward New York: Avon Books 11. Tillliss T et al. The transtheorectical model applied to an oral self-care behavioral change: Development and testing of instruments for Stages of Change and Decisional Balance. J Dent Hyg 2003; 77: Tedesco L et al. Self-efficacy, reasoned action, and oral health behavior reports: a social cognitive approach to compliance. J Behav Med 1991; 14: Stewart JE et al. Changes in dental knowledge and self-efficacy scores following interventions to change oral hygiene behavior. Patient Educ Couns 1996; 27: Slot DE et al. The efficacy of interdental brushes on plaque and parameters of periodontal inflammation. A systematic review. Int J Dent Hygiene 2008; 6: Berchier CE et al. The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: A systematic review. Int J Dent Hygiene 2008; 6: Hoenderdos NL. The efficacy of woodsticks on plaque and inflammation: A systematic review. Int J Dent Hygiene 2008; 6: Husseini A et al. The efficacy of oral irrigation in addition to a toothbrush on plaque and the clinical parameters of periodontal inflammation: A systematic review. Int J Dent Hygiene 2008; 6: Assadorian J. Canadian Dental Hygienists Association Position Statement: Flossing. CJDH 2006; 40: Hujoel PP et al. Dental flossing and interproximal caries: A systematic review. J Dent Res 2006; 85: Graves et al. Comparative effectiveness of flossing and brushing in reducing interproximal bleeding. J Periodontol 1989; 60: Lewis MW et al. Comparison of the use of a toothpick holder to dental floss in improvement of gingival health in humans. J Periodontol 2004; 75: Kleber CJ, Putt MS. Formation of a flossing habit using a floss-holding device. J Dent Hyg 1990; 64: Carter-Hanson C et al. Comparison of the plaque removal efficacy of a new flossing aid (Quik Floss ) to finger flossing. J Clin Periodontol 1996; 23: Shibly O et al. Clinical evaluation of an automatic flossing device vs. manual flossing. J Clin Dent 2001; 12: Barnes CM et al. Comparison of irrigation to floss as an adjunct to tooth brushing: Effect on bleeding, gingivitis, and supragingival plaque. J Clin Dent 2005; 16: Sharma et al. Effect of a dental water jet with orthodontic tip on plaque and bleeding in adolescent patients with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop 2008; 133: Al-Mubarak et al. Comparison evaluation of adjunctive oral irrigation in diabetes. J Clin Periodontol 2002; 29: Chaves ES et al. Mechanism of irrigation effects on gingivitis. J Periodontol 1994; 65: Cutler CW et al. Clinical benefits of oral irrigation for periodontitis are related to reduction of pro-inflammatory cytokine levels and plaque. J Clin Periodontol 2000; 17: Flemmig TF et al. Supragingival irrigation with 0.06% chlorhexidine in naturally occurring gingivitis. I. 6 month clinical observations. J Periodontol 1990; 61: Flemmig TF et al. Adjunctive supragingival irrigation with acetylsalicylic acid in periodontal supportive therapy. J Clin Periodontol 1995; 22: Hoover DR et al. The comparative effectiveness of a pulsating oral irrigator as an adjunct in maintaining oral health. J Periodontol 1971; 42: Newman MG et al. Effectiveness of adjunctive irrigation in early periodontitis: Multi-center evaluation. J Periodontol 1994: 65: , Water Pik, Inc Page 5

6 34. Gorur A et al. Biofilm removal with a dental water jet. Compend Contin Ed Dent 2009; 30(Suppl 1): Cobb CM et al. Ultrastructural examination of human periodontal pockets following the use of an oral irrigation device in vivo. J Periodontol 1988; 59: Felo A et al. Effects of subgingival chlorhexidine irrigation on peri-implant maintenance. Am J Dent 1997; 10: Krajewski J et al Evaluation of a water pressure cleaning device as an adjunct to periodontal treatment. J Amer Soc Periodont 1964; 2: Braun R, Ciancio S. Subgingival delivery by an oral irrigating device. J Periodontol 1992; 63: Jolkovsky DL et al. Clinical and microbiological effects of subgingival and gingival marginal irrigation with chlorhexidine gluconate. J Periodontol 1990; 61: , Water Pik, Inc Page 6