Adherence and Communication

Abstract

Patient adherence is the extent to which an individual follows the treatment regimen that was prescribed during a medical visit. It is estimated that 25 percent to 50 percent of patients are nonadherent, with varying rates across different conditions and treatment regimens. Nonadherence is a widespread problem and can negatively influence health outcomes, including disease progression and worsening of symptoms. In addition to negatively influencing health, nonadherence can also be costly. It is estimated that several hundred billion dollars spent on health care annually in the United States is due to nonadherence. Many different factors play into whether a patient is adherent, including complexity of the regimen, side effects, mental health, level of social support, and cost. A significant factor that is known to influence adherence is the quality of provider-patient communication. Health-care providers play an important role in promoting adherence for their patients, through educating patients about their disease and regimens, sharing decisions about the course of treatment with the patient, conveying the important implications of adherence, and providing support when patients face barriers to adherence. Communication during the medical visit plays an important role in determining whether a patient will adhere. This article will provide an overview of the literature on communication and adherence, focusing on topics such as information giving, shared decision making, nonverbal communication, trust, empathy, patient-centered communication, and health literacy.

Prospects for H-mode inhibition in negative triangularity tokamak reactor plasmas

“…For example, if for a particular scenario δ l = −0.2 is strong enough to push the positive region of the local shear on the bottom of the tokamak from the good curvature to the bad curvature region, 2nd stability access will be prevented no matter the value of δ u . Similarly, earlier work on the effect of asymmetry has suggested that the minimum of δ l and δ u matters more for kinetic ballooning mode stability than the maximum δ by roughly a factor of 2:1, which leads to a 2/3 weighting of the minimum triangularly in the EPED code [39]. These results emphasize the importance of achieving low local shear across the entire bad curvature region in 2nd stability access, and are consistent with studies of varying upper triangularity on DIII-D and TCV [21,22].…”

“…However, a factor of ∼10 increase in the ELM frequency was reported with loss of access to the 2nd stability region, along with a corresponding decrease in the ELM amplitude and height of the H-mode pressure pedestal. Select discharges in ASDEX and Alcator C-Mod have also been observed to achieve H-mode while remaining in the 1st stability stability region by operating at high collisionality, which then suppresses the bootstrap current and prevents the edge shear from dropping below the critical value needed for ballooning stability [38,39]. Again, 1st stable H-mode operation in these cases is associated with a strong reduction in the ELM amplitude.…”