Topic 6: Review What Has Already Been Tried
A list of prior treatments is not enough. Determine what was used, for how long, whether the patient could follow the plan, what improved, how long improvement lasted, what adverse effects occurred, and why treatment stopped.
North American Guidelines recommend selecting treatment according to disease severity and prior response, making an accurate treatment history essential to the next decision.9
Clarify apparent treatment failure
- Was the treatment intended for an acute lesion or long-term disease control?
- Did the patient experience a partial response?
- Was the treatment utilized alone or in combination with other treatments as part of a regimen?
- Was the dose and duration adequate for the intended purpose?
- Did the patient obtain and use it as planned?
- Were cost, coverage, transportation, refrigeration, injections, dressings, or time barriers involved?
- Did pain or drainage improve even if lesion counts did not?
- Did benefit disappear after treatment ended?
- Were procedures performed, and did disease recur at or near the treated site?
- What outcome matters most to the patient now?
| Important distinction: Nonadherence is a description, not an explanation. Ask what made the plan difficult before concluding that the patient was unwilling to follow it. |