Page 26 - Mobility Management, March/April 2021
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ATP Series
The Problem with Compliance
the patient for their behaviors in a very simplistic way and without acknowledging the very real complexities around adherence-re- lated behaviors,” Friesen said. “So from the early 2000s, there was a lot of work done to gain consensus around this term of adherence and this idea of adherence to reflect a more holistic approach,
one where there is agreement, there is dialog between an HCP [healthcare provider] and a person or patient around a particular treatment or intervention. It has become a consensus term. The World Health Organization, movements around the world, policy makers, care practitioners, manufacturers, researchers, patient organizations, patient advocacy organizations are all very much on board with this idea of adherence and adherence-related sciences and the management of adherence.”
The principles of adherence are an especially good fit for this industry, Friesen said. “In seating and mobility, we strive to be
user centered. We strive to be patient led, and to me it would make sense then that we would embrace this terminology and the evidence from adherence-related sciences. Because it is fundamentally looking at the issue in a way we would want to look at it, which is putting the patient at the center and under- standing their needs, wants, beliefs, and realities.”
Where the compliance model identifies healthcare profes- sionals as authoritarians, adherence contends that clients and caregivers are also subject matter experts.
“We’re recognizing that the person and their circle of support have expertise in their own lived experience of their condition,” Friesen said. “All of those can potentially impact adherence. You can be intentional in your adherence or non-adherence, or you can also be unintentional, like ‘I forgot.’ The conversation allows us to take into account all these very important person-centered
ATP Caitlin Miller: Wheelchair Experience Is a Journey
Caitlin Miller, OTD, OTR/L, ATP, is a Numotion ATP Ambassador Council Member who has worked as a seating and wheeled mobility clinician and now works as an ATP supplier. She was asked why compliance is such a challenge.
Wheelchair Provision Is a Process
“Unfortunately, I think this issue is more common than we might like to believe,” she said. “In reality, wheelchair fittings can be busy and sometimes hectic, especially if done in a clinic setting. This is why it’s imperative to maintain an open line of communication with your clients.”
Miller said she explains seating and mobility assessment and fitting as a process. “As cliché as it might sound, I typically like to frame the new wheelchair experience as a journey... I ensure my clients know this is not a one-time-fitting-then-done type of thing. It’s common for me to go back after delivery to make small adjustments or re-educate.
If it’s a new injury or diagnosis, this process can be overwhelming, and we can’t possibly expect to accomplish everything in one hour. The after-delivery follow-up is an area that we need to capitalize on. This is where relationships and trust are built and where compliance and overall satisfaction can be guaranteed.”
“Incredible Opportunity”
for Education
Miller was asked if non-compliance is sometimes the result of consumers and
caregivers being too busy or feeling overwhelmed. How often does life get in the way of, for example, remembering to check the inflation of air cells in a cushion?
“Hey, I get it,” Miller said. “I’m a mom who works full time, has two kids, and can’t seem to keep up with my car keys... let alone being a caregiver for a medically complex individual or keeping up with my own complex needs.
“I’ll start by saying the caregivers of
my clients are superheroes, right along with the clients themselves. However, again, I see an incredible opportunity for education here. Of course, we know that tilt/recline aren’t just fancy features we put on a chair just because... but more
so because they have an actual medical purpose. Providing education in this manner might make caregivers and clients more aware of the fact that tilt/recline/ maintaining adequate air pressure can be just as beneficial for their overall health
as is their daily medication. Also, I believe in making things realistic and practical. Setting practical expectations for pressure relief as well as introducing technology available on our equipment — pressure relief reminders — are all ways we can make things easier and increase overall compliance.”
Given how busy wheelchair users and their families can typically be — and the overwhelming number of activities required every day for someone with a complex medical condition — what can
seating and mobility teams do to help improve client compliance?
“I think the question actually answers itself,” Miller said. “It’s in having a well- rounded team of professionals that can provide comprehensive care. The ATP/ therapist/doctor relationship is invaluable! When I worked as a therapist, I worked with ATPs I knew I could count on. I knew that if I referred to them, I could count on their knowledgeable equipment recom- mendations, I trusted they were ethical in their paperwork completion, and I knew that if/when my patients needed service, they would be there... and ultimately, it’s because of that trust that I would later go on to work for Numotion.
“When we can form a comprehensive team around a client,” Miller added,
“we essentially remove their burden. When we make it easy to understand the information, make ourselves available for questions, and ensure a seamless process, we can increase overall compliance and willingness.” m

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