Physician Interaction and Counseling of Filipino Patients

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Physician Interaction and Counseling of Filipino
Patients

• Filipino American Cardiovascular Health
  Conference
• National Harbor, MD
• July 8, 2011
• Potri Ranka Manis Queano Nur, MA, RN
• Kalusugan Coalition, Inc.

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Objectives

• To cite situations of Filipino Americans that may
  help explain underlying behaviors, attitudes,
  and perceptions of health and determine health
  outcomes and health disparities.
• To describe socio-cultural factors impacting
  Filipino Americans non-adherence to medication
• To examine cases of physician interaction and
  counseling of Filipino patients
• To highlight the importance of understanding
  various barriers Filipinos encounter when it
  comes to medication adherence and the best way to
  communicate without labeling a patient as
  "non-compliant".

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The Clinical Encounter

• Patients Barrier Lack of health
  insurance/coverage --gt Association of clinical
  encounters with cultural stigma (i.e. death, high
  costs, poor self-care)
• Is it hiya, or just fatalism? God take me,
  they say They know theyre sick and have high
  blood, but going to the doctor is just going to
  lead to high costs and things getting worse, not
  better and more disruption with other parts of
  their life, like work, church, family, social
  functions. - AsPIRE Community Health Worker

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Case Study

• Perry is 57/female years old. She was an
  architect in the Philippines. Currently working
  as a manager of a nurse staffing agency.
• " I was in the ER last week. My blood pressure
  went up to 200/110. I thought I will die. I am in
  medication but it makes me cough. I went to see
  my doctor, she gave me cough medication. She was
  so in a hurry that I was not able to ask her more
  questions that is related to what I am feeling. I
  stopped taking the medication. I saw her in a
  party and I thought I can speak to her about me
  but when I told her I have a headache and a
  backache she said I needed an MRI. I stopped
  seeing that Doctor. Right now I am just taking
  the medicine when I feel my BP is high.

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Physician-Patient Communication in the Primary
Care Office systematic Review Rainer Beck, MD,et
al

• According to Dr. Beck, et al study,
  Physician-patient communication has frequently
  been judged to be inadequate.
• According to Dr. Mcbride et al study it was found
  that patients considered communication to be one
  of the top three competencies a physician should
  possess, yet they frequently rated their own
  physicians' communication skills to be
  unsatisfactory.

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Qualitative Studies on Filipino Americans
Medication Adherence

• The Role of Sociocultural Factors on Medication
  Adherence and Control of Hypertension Among
  Filipino Americans A Qualitative Study -
  Gregory S. Calip, PharmD, MPH, 2009
• The Illness beliefs, perceptions, and practices
  of Filipino Americans with Hypertension
  Felicitas Dela Cruz, 2007
• Nonadherence due to forgetfulness because of
  multiple family responsibilities and time
  constraints.

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Environmental Characteristics

• Patient barriers
• Immigration status and recent migration
• Lack of time for self care
• Prioritization of employment versus health status
  
• Cultural perception of health

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Immigration Status and recent migration

• Immigration status. Displacement of status.
• It can be silent in the written survey that most
  of the domestic workers are teachers,
  accountants, engineers, lawyers, nurses, even
  doctors in the Philippines. One of the recent
  encounters in a recent health screening, the
  client was a Mayor in his town in the Philippines.

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Lack of time for self-care

• Most Filipino immigrants have 2-3 jobs to meet
  the economic demands here plus the demands of
  their family/extended family back home in the
  Philippines.
• Managing high blood among my clients is only
  possible if they knew they had the time/ability
  to work, send money home to the Philippines, and
  then take time to see the doctor. AsPIRE CHW

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Prioritization of employment versus health status

• Filipino immigrants/recent immigrants who work 2
  jobs and 7days a week often note they have no
  time to go to health providers for their health
  care needs.

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Cultural Perceptions of Health

• There are those who stop when they feel better or
  their blood pressure becomes normal and
  mistakenly believe that they no longer need the
  medication or that they thought they were cured.
  Some just simply forget taking their medication.

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Cultural Characteristics

• Chronic nature of hypertension management
• Cultural perception of well being
• Folks in our community cant FEEL their high
  blood pressure they tell me they feel fine if
  they have time to work and dont see the bigger
  picture until someone they know gets sick or
  dies. Community Health Worker, Jersey City, NJ

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Lack of understanding and Information

• Low awareness of treatment Risk factors,
  Characteristics, Complications
• Most knowledge acquired from sources other than
  health providers
• Long term use of medication drug-taking
  contingent to symptoms
• Clients of mine receive medications from family
  members or doctors in the Philippines because
  theyre cheaper. They share them because they
  think it worked well for their relative. They
  might know they have high blood from a screening,
  but never saw a doctor because they couldnt
  pay. Community Health Worker, Queens, NY

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Physician as a Patient Educator
(Diane Florde McCANN, EdD, et al.) A Establish
rapport by eliciting patients ACTIVE
INVOLVEMENT D Assess needs by listening
carefully as a patient DISCUSSES
CONCERNS U Develop a plan by promoting an
UNDERSTANDING OF THE ISSUES L Implement the
plan by offering patient opportunities to LEARN
NEW BEHAVIORS T Evaluate the plan by
identifying strategies for TRACKING PATIENTS
PROGRESS
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Art of Communication

• Judgmental Feedback
• Language Barriers
• Trigger defensiveness, aggression, or resistance
• Example
• Youre 35 years old. You should be pregnant by
  now.
• spoken by a Filipina OB/GYN doctor to a
  Filipina patient.

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Art of Communication
Keys to Active Listening
Seven Levels of Listening

• Block out obstacles to listening such as noise
• Full attention not on the cellphone Maintain
  eye contact (remember cultural variations)
• No interruptions allow the person to speak,
  nodding is acceptable
• Ask the person to repeat in the event you dont
  understand
• Acceptable to take brief notes to keep track of
  details

• Non-listening too busy thinking about your own
  response or feelings
• Avoiding tuning out what we dont want to hear
• Blaming The blame game
• Negating You should not feel that way
• Top This Let me tell you
• Interest Tell me more
• Reflective What I hear you say is

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CHW/Adjunctive Instructions

• Egbert and colleagues were among the first
  investigators to report the positive effects of
  adjunctive patient instruction by members of an
  interdisciplinary health team.
• Combination of cognitive and motivational and
  skill-building education and reinforcement from
  the community health worker
• Community health workers can be part of a team
  approach to patient education as an adjunct to
  personal physician education through regular
  physician visits

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• THANK YOU!
• For more information please contact
• Potri Ranka Manis Queano Nur, MA, RN
•  
• 39-04 63rd Street
• Woodside, NY 11377
•  
• Phone [phone]
• Fax [phone]
•  
• Email info_at_kalusugancoalition.org
• Website www.kalusugancoalition.org
• Facebook www.facebook.com/kalusugancoalition
• Twitter www.twitter.com/kalusugan