Healthy Relationship Increases Patient Compliance
by Dr. Richard Drucker, B.S., M.S., N.D., Ph.D.
As a health-care provider, our primary challenge is to get our patients to follow specific nutritional and supplemental recommendations and protocols we feel will provide them with maximum benefits. As we all are aware, this task is often more difficult than it first appears. In fact, to support this, a task force found that compliance rates are only in the 30% to 60% range for common chronic conditions.1 Patients have the same compliance problems with prescription medications. One study revealed that one-third of the monitored patients took all their medicine; one-third took some of their medicine; and one-third never filled their prescriptions.2 Compliance is challenging in both the allopathic medicine and naturopathic fields.
Patients generally fall into two broad categories. There are those who prefer to be very limited in their decision-making involvement. These patients primarily tend to be older, possibly in poor health, and trust the health-care provider as the schooled and respected authority. This patient type almost always will take whatever is recommended. The second type is the patient who prefers to be actively involved in making decisions regarding health care and nutritional choices and treatment. These patients, who generally are younger and better educated, or who may have been actively self-managing a chronic illness for some years, tend to be less satisfied with their health care.3 They rely on the wealth of available printed and internet health material to educate themselves before they meet with their health-care providers and search out various doctors and/or make decisions regarding their own care.
In order to achieve better over-all compliance, health-care providers use various techniques, mindsets, and terminology to help their patients. The second type of patients requires this unique approach, so that they can see the benefits in following an established protocol. Rather than use the term compliance, which refers to an involuntary act of submission to authority, health-care practitioners have adopted the word “adherence” as a better description. Adherence is a voluntary act of subscribing to a point of view—it reflects a different viewpoint for patients to follow recommendations and, therefore, requires a more unique approach. Because adherence focuses on the voluntary act, others factors may make the protocol plan more difficult. Some of the factors are:
• Forgetfulness (forgetting how or when to take a supplement)
• Detoxification reactions
• Unreal expectations, such as expecting a quick fix or cure
• Individual personality
• Difficulty in swallowing pills or capsules
• Few or no presenting symptoms
• Lack of or slow results
• Poor protocol instruction
• Confusing or complicated regimen
• Physical sensitivities and tolerances
On the flip side, adherence can be more effective when one perceives that a particular need or desire will be met by following specific nutritional recommendations. A patient must be ready for care in order to be more compliant or adherent. Since most clients in the alternative health care arena do have a need and, thus, are seeking a solution, there is an advantage when recommending supplements.
When it comes to nutrition, additional factors that help to increase a patient’s adherence include over-all knowledge of the product—the ingredients, its effectiveness, their tolerance, and how others with similar health concerns have benefitted, the history of the product and manufacturer, proper and simple protocol instructions, and that the results outweigh the cost. Much of this is relative to the patient’s desire to get better.
Keeping in mind the second type of patient who has done research and searched for his/her health-care professional, one of the most effective ways to reinforce adherence is through a beneficial health-care provider/patient relationship. Good communication between the two is extremely important. In this relationship, factors that may come into play are age, habits, convenience, desire to get well, and money. Modern health communication warrants that health-care providers do not ignore statements from their patients about their health and related factors, but that they trust them.
Part of the initial consultation, when setting up a course of action for treatment, involves asking the patient what other sources he/she has consulted for information about their condition and what other medicines or supplements they have taken for it. From there, the health-care provider can help them make better sense by directing the patient to the information and supplements they require to help them best. Patients are the best source of information about themselves. It has been shown that, if the patient’s own words and language can be used whenever possible, this will increase patient satisfaction significantly with their health visit or consultation.4 You need to work with the patient to:
• Determine the patient’s expectations and definitions
• Confirm what information you need from the patient
• Acknowledge differences and similarities in values or points of view
• Encourage problem-solving
• Empathize with the current situation
• Recognize any difficulties or complaints
• Agree on a diagnosis and course of action, including which particular supplements are to be used
• Be open minded to new ideas and treatment modalities
The risk of a patient quitting a long-term treatment grows greater when that treatment stabilizes a condition, rather than relieves the symptoms. If this stabilization occurs, the health-care provider should go over the patient’s history and review their original complaints. Often, a patient will forget the severity of the initial symptoms and a review helps to emphasize the improvement they have made and the importance of continuing a prescribed course of treatment. Prevention is better than treatment.
Occasionally, a patient will experience detoxification reactions when they begin to receive the good nutrition that has been lacking for so long. If the client does not expect that kind of reaction, they may respond negatively and discontinue the treatment plan. Adherence in nutritional supplementation also improves when the supplements are easy to take, are complete and few in number, and are in a form that is easily swallowed and digested, as in an organic liquid form that tastes good. Clear and easy-to-remember instructions on how to take the product is important as well.
If a health-care provider already has a working relationship with a patient, they know from previous care how eager he/she is to participate in decision making and self-care. However, if the patient is new and the health-care provider is unsure, the best approach is to ask. This way, the patient’s expectation for involvement may be better understood, and their particular nutritional needs will enable the health-care provider to better modify his or her approach. Over time, the adherence approach will help to build stronger relationships with patients, increasing their loyalty to the health-care provider and to their practice.
Dr. Drucker has a Master’s of Science in Natural Health and a Doctorate in Naturopathy. He is a highly respected doctor in the field of natural health and the CEO of Drucker Labs, which manufactures and distributes health, wellness and nutritional products. These products use a breakthrough technology called intraCELL™ V, which yields unique carbon-bond organic microcomplexed structures that are highly bio-available and extremely effective. You may contact Dr. Drucker at 866-693-4810.
Nelson, AM, Wood, SD, Brown, S, Bronkesh, S with Gerbarg, Z. Improving Patient Satisfaction Now: How To Earn Patient and Payer Loyalty. 1997. Gaithersburg, MD: Aspen Publishers, Inc.
Hayes, R.B.NCPIE Prescription Month, October 1989
Anderson, LL, DeVellis, RF, Boyles, B, Feussner, JR. Patients’ perceptions of their clinical interactions: Development of the multidimensional desire for control scales. Health Education Research. 1989;4(3):383-397.
Rowland-Morin, PA, Verbal communication skills and patient satisfaction: A study of doctor-patient interviews. Evaluation & The Health Professions. 1990;13(2):168-185
Over 50 million Americans suffer from hypertension (high blood pressure). Hypertension
Affects one out of every four adult Americans. Almost 43,000 Americans die from hypertension each year. Another 227,000 die from causes related to hypertension.
The arteries have thick, elastic, and muscular walls that relax and open wide as blood flows through them. The layers of arterial wall include the endothelium, which serves as a physical barrier between the flowing blood, and the next layer known as media.
The endothelium is quite complex. It is the largest organ in the body and weighs almost five pounds. If you were able to lay it out flat, it would take up 14,000 square feet. This is roughly the size of six and a half tennis courts.
The media is a layer of smooth muscles that contracts (tightens) or relaxes on demand. The tightening or relaxing of the media causes the blood vessel to become narrower or wider. This is one way the arterial system controls blood pressure and blood volume.
Definition of Hypertension
An excess in blood pressure increases the amount of force exerted by the blood it courses through the artery. This increased force may damage the endothelial lining of the artery wall. Damage to the blood vessel wall leads to atherosclerosis or hardening of the arteries.
Normal blood pressure is 120/80mm Hg; 120-130/80-90 is pre-hypertensive. And, if the systolic pressure is above 140 or if the diastolic pressure is above 90, this is indicative of hypertension.
Stage I hypertension occurs when the systolic pressure is between 140-159 or diastolic pressure is between 90-99.
Stage II hypertension occurs when the systolic pressure is above 160 or if the diastolic pressure is above 100.
Individuals who are in Stage I have a 31 percent greater risk of heart attack, almost twice the risk of stroke, and a 43 percent increase in death rate, compared to individuals with normal blood pressure.1
Essential hypertension is high blood pressure that has no definitive cause. This is the case for 95 percent of the cases of hypertension.
Secondary hypertension is high blood pressure due to another condition, such as kidney disease, diabetes, prescription medications, allergic reactions, and chemical sensitivities.
Typical hypertensive drugs include diuretics (water pills), calcium channel-blockers, beta-blockers, ACE inhibitors, and specific vasodilators—all have unwanted side effects.
Common Anti-Hypertensive Medications2 Calcium Channel Blockers
Calcium channel blockers increase the risk of heart attack and death by five-fold and may cause fatigue, flushing, swelling of the abdomen, ankles, or feet, heartburn, tachycardia or bradycardia (slow heart rate), shortness of breath, difficulty swallowing, and dizziness, numbness in hands and feet, and gastrointestinal bleeding.
Beta blockers have several potential side effects including congestive heart failure, shortness of breath, heart block, fatigue, lethargy, drowsiness, depression, insomnia, headaches, dizziness, tingling in the hands and feet, wheezing, bronchial spasm, increased severity of asthma or chronic pulmonary obstructive disease, decreased sex drive, muscle fatigue, reduced HDL (good cholesterol), increased LDL, and triglycerides.
Angiotensin-Converting Enzyme (ACE) Inhibitors
Potential side effects include a dry cough, gastrointestinal disturbances, numbness or tingling in the hands and feet, joint pain, fever, lightheadedness, and fatigue.
Angiotensin II Receptor Blockers
Potential side effects to these medications include headache, upper respiratory infection, cough, dizziness, sinusitis, throat inflammation, diarrhea, fatigue, back pain, viral infections, and abdominal pain.
Diuretics may cause the following side effects: excessive uric acid in the blood (gout), magnesium deficiency, potassium deficiency, electrolyte imbalance, muscle cramps, fatigue, headaches, lowered HDL, excessive sugar in the blood (diabetes), fever, rash, irregular menstrual cycles (aldosterone), impotence (same), excessive urination and thirst, and some have been shown to cause an eleven-fold increase in diabetes.
Natural Approaches to Reducing Hypertension
AmealPeptide® is a natural ingredient derived from nonfat milk that acts as a natural inhibitor of angiotensin. It consists of the two peptides, valyl-prolyl-proline and isoleucyl-prolyl-proline, that are naturally occurring substances also found in fermented dairy products, such as cheese and yogurt. AmealPeptide® has been evaluated in 14 double-blind and placebo-controlled clinical studies, which have shown that it lowers elevated blood pressure and maintains it at healthier levels.3
Fish oil reduces blood pressure, inflammation, fibrinogen, irregular heart beats (arrhythmia), atherosclerosis, triglycerides, and platelet aggregation.4,5
The New England Journal of Medicine reported on a study that showed individuals consuming 15 grams of fish oil a day whose blood pressure dropped significantly. Typically between 4-7 grams of fish oil are needed for a 1.6-2.9mm Hg drop in blood pressure. If the dose is increased to 15gm of fish oil, the blood pressure drops 5.8-8.1mm Hg. Individuals who lose weight and take fish oil supplements may reduce their systolic blood pressure by 13 points and their diastolic by 9 points.
CoQ10 significantly improved diastolic and systolic pressure in essential hypertension. More than half of patients receiving 225 mg/day were able to terminate use of from one and three antihypertensive medications. Studies show that taking 100-225mg of CoQ10 a day reduces systolic blood pressure by an average of 15 points and diastolic pressure by 10 points.6 Lose Weight: It is estimated that it takes one mile of capillaries (smallest blood vessels) to supply each pound of fat. This is an extra one-mile of vessels the heart must pump blood through. What if you are 10-20 pounds overweight? This translates to 10-20 extra miles of capillaries that must be serviced by the heart. However, losing just 10 pounds of weight results in an average decreased systolic pressure of 7 percent and a drop of 5 points in diastolic pressure. A one-point drop in diastolic pressure results in 3% decreased risk of heart disease and a 7% decreased risk of stroke.2
A weight gain of 10% can increase systolic blood pressure by 6.5 points.2
Low Salt Diet
Americans consume 6-10 grams of salt a day. We actually need around 500mg a day.
It’s estimated that up to 60% of hypertensive patients are salt sensitive. Processed foods account for almost 75% of a person’s daily salt intake. Studies show that salt restricted diets can reduce systolic pressure by 11.5 and diastolic pressure by 6.8 points. And one third of patients on hypertensive medications could discontinue them altogether by reducing their salt intake to 1,800 milligrams or less per day.1
Even though drug companies continue to promote hypertension as a drug deficiency, diet, nutritional therapy and lifestyle changes may be as effective as and, certainly, safer than drug therapy alone.
Dr. Murphree is a board certified nutritional specialist and chiropractic physician who has been in private practice since 1990. He is the author of 5 books for patients and doctors, Treating and Beating Fibromyalgia and Chronic Fatigue Syndrome, Heart Disease What Your Doctor Won’t Tell You and Treating and Beating Anxiety and Depression with Orthomolecular Medicine. To contact Dr. Murphree or for more information about his Doctors VIP One-on-One Nutritional Coaching Program, visit www.Essentialthera.com or call 1-888-884-9577.
1. Mark Houston, What Your Doctor May Not Tell You About Hypertension. New York: Time Warner, 2003.
2. Rodger Murphree, Heart Disease- What Your Doctor Won’t Tell You (2nd edition). Birmingham AL: Harrison and Hampton, 2008
3. Medical News Today, “Blood Pressure Lowered By Calpis’ Ameal Peptide In 2 Placebo-Controlled Trials” (2008), www.medicalnewstoday.com/articles/107888.php
4. Knapp HR, Fitzferald GA. The antihypertensive effects of fish oil: a controlled study of polyunsaturated fatty acid supplements in essential hypertension. New Engl J Med. 1989;320:1037–1043. JANA 28
5. Morris M, Sacks F, Rosner B. Does fish oil lower blood pressure? A meta-analysis of controlled trials. Circulation. 1993;88:523-533
6. Langjoen P, Willis R, Folkers K. Treatment of essential hypertension with coenzyme Q10. Mol Aspects Med. 1994;15:S265-S272