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Adherence management coaching (AdM coaching) is an evidence-based applied behavioral approach for significantly improving patient adherence and reducing unplanned hospital readmissions. It is based on the research and work of Bob Wright, Aubrey Daniels and BF Skinner. AdM coaches identify patients at high risk for readmission as a direct result of not following their discharge plan. Once identified, AdM Coaches work with these patients (patient engagement) to identify consequences (consequence analysis) with their plan of care that might result in non-adherence. Together, with their provider, AdM Coaches establish a patient centered adherence improvement plan (AIP). The AIP is used to identify target behaviors, desired results (clinical outcomes) and reinforcers that support following their plan of care and developing adherent habits. Following hospital discharge, at-risk patients, and their families, are followed and coached by an AdM Coach for several months as the adherent replacement habits are developed and strengthened.
Home and work environments are filled with cues of a lifetime of habits. While meeting with at-risk patients and their families, AdM coaches identify these cues and work with the family to replace them and reinforce healthier habits. All new behaviors, if not reinforced, will return to the life-style habits that contributed to hospitalization in the first place. Adherence management provides a coaching toolkit to be used in conjunction with Teachback,motivational interviewing, pill counting, biochemical measurements, pharmacy data-base of usage and Directly Observed Treatment Short course (DOTS).
World-wide, half of all patients choose to not follow their plan of care. Current programs, like the teach-back method, focus on teaching all patients, just prior to their discharge, the new information they need to follow to once they go home. Motivational Interviewing takes more nurse educator time as together, with the patient, they attempt to identify and overcome areas of ambivalence concerning their disease process and plan of care. Other programs focus on alerting devices and pill-minders to aid patients in remembering to take their medications on time. At best, these "cues" or antecedents have had a marginal impact on improving adherence.
The Centers for Medicare and Medicaid Services has extended provider responsibility and accountability well beyond the front doors of clinics and hospitals. CMS, in responding to a hospital question concerning levels of responsibility following discharge, responded writing, "Post discharge care is a joint responsibility."
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