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COMMUNICATIONS

Compliance and Adherence: Dysfunctional Concepts in Sleep Apnea Care

by Pat Mc Bride, BA, RDA, CCSH, Sleep Clinician

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-PAP, oral appliance, medication, orthodontic, myofunctional therapy and dietary compliance/adherence are some of the everyday buzz words in the worlds of medicine and dentistry. A quick internet search reveals thousands of citations that either seek to identify or resolve problems around the non-compliance/adherence issue for breathing, sleep disorder therapy and numerous other chronic illnesses. It must be understood that successful treatment of most chronic disorders requires high levels of patient engagement and self-management. The numbers of studies citing issues with compliance/adherence show that what has been the gold standard methodology in patient management simply isn’t working for large numbers of patients. They also do not mention how compliance, or lack thereof, manifests itself in strained physician/patient relationships. Compliance/adherence theory stems from a traditional view of healthcare relationships developed during a time when most mortality and morbidity was caused by acute illness (Vital Statistics of the US, 1974). Patients got sick, they died, no follow up required. Disease management referred generally to the physician mandating what was best for the patient

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with no patient involvement in either treatment planning or therapy decision making. Breathing and sleep disorders are chronic illnesses, and primary therapy management is the responsibility of the patient. As care providers we are motivated by knowing that the consequences of untreated and poorly managed sleep apnea not only affects the individual patient, but their families and society as a whole. Overall increased healthcare costs, work related accidents, loss of income, automobile accidents are just a few highly impacted areas. We were all trained in school to believe that compliance/adherence management of disease is somehow in our control, and if a patient fails to “comply” we have failed in our duty to treat them. Our core beliefs about what patients should or should not do often colors our clinical perceptions and how we view patients as individuals. It can and does lead to frustration and difficulty when what we believe and what actually occurs with a patient do not sync. Compliance/adherence theory fails to address major concerns from the patient perspective. Of primary concern is the notion of control. The patient needs to be fully in control of all self-management decisions. Most of the frustration stems from our wish as providers that patients would maximize their self-management levels. Many of us lament that we feel more invested in our patients sleep apnea care than they do. If we’re honest, labeling a patient

Dental Sleep Practice 2017 Spring  
Dental Sleep Practice 2017 Spring