Reference no: EM13458316

Background

Bill is a 51-year-old Caucasian male who has chronic diabetes and hypertension. He has been seen at the clinic by a number of specialist physicians over the past 6 years. Married for 24 years with no children, Bill has recently been placed on medical disability after working at a telephone company for 18 years. His diabetes has advanced, and his blood pressure readings have been consistently elevated recently.

Problem

Bill has had prescriptions for medication for his diabetes and hypertension for 5 years, but he often misses doses or refuses to follow dosage instructions. He also has had scheduled appointments with a dietitian and exercise therapist, but he misses appointments or fails to follow their instructions to improve his eating and activity. Although the team members at the clinic have all tried very hard to work with him, he has refused to follow through.

Behavioral Health Information

Bill is slightly overweight. His eating patterns and appetite are normal, although he does not follow the guidelines recommended by his dietitian. Sleep patterns indicate some sleep restriction, and he averages only 5 hours of sleep per night. His sexual interest and desire is reduced, and he has had problems with erectile dysfunction. Although he went to the gym briefly several years ago, he is not physically active at this time other than occasional walks with his dog. Because he no longer works, he is quite sedentary, filling most of his day watching sports on TV and playing games on the Internet. He smokes about 10 cigarettes per day and reports having several beers on weekends. Caffeine use is minimal. He has a good but somewhat distant relationship with his spouse. He has few friends since leaving work and little social support aside from his wife. Overall, he has little structure in his life. He has a pessimistic attitude toward life in general and feels badly about his medical problems and his inability to work or have sex. He has not been seen by a mental health clinician, but there is likelihood of depression.

Write a 1,200- to 1,500-word paper discussing the following:

The definition of adherence
The factors that predict adherence, including patient and provider variables
Treatment regimen variables
Patient-provider communication
A description of the evidence-based factors affecting the patient-provider relationship, including provider communication problems and patient communication problems.
What evidence-based techniques would you recommend to improve Bill's adherence to treatment?