Reference no: EM132828789

Te Family Health Center (FHC) is in an urban area of a mid-size city in the Midwest. Te clinic prides itself on being a neighborhood partner with a respected and trusted reputation. Te clinic has a variety of clients of all ages, ethnic and cultural backgrounds, and varying socioeconomic status. Te clinic has a large waiting room, several examination and treatment rooms, a countertop lab, and cubicle offices for the staff. Te clinic is open daily with some evening hours. It is closed on weekends. FHC is staffed by physician assistants (PA), nurse practitioners (NP), registered nurses (RN), a part time social worker, a part-time registered dietitian nutritionist (RDN), and a health information management specialist. All clients are seen on an appointment basis, and a significant percentage of the clients are seen routinely for chronic illness visits. Many of the clients have comorbidities with most frequently seen ICD 10 codes of I10 (hypertension), E66.9 (obesity), and E11.9 (diabetes mellitus II). Last year the FHC opened a specialized preconception program for their clients. It is the only program of its kind in the city and offers physical exams, lab evaluations, lifestyle coaching, and weight management. These are the same services offered to their regular clients but customized for the unique needs relating to conception. Weekly health care team meetings are held to review progress in FHC chronic disease clients. During the report, comments frequently revolve around the frustration of seeing clients on a regular basis who do not seem to progress as expected. Comments have included, "She gained another two pounds again this month; she knows her weight loss is a critical part of her treatment"; "I've told him for the last six visits, he needs to lay of the salt shaker"; "I've talked until I'm blue in the face, but he still doesn't eat his meals at regular times"; "She still is not checking her blood sugars like she should"; "If he takes half of his medication every month it's a good month"; " She missed her appointment again with the pediatric endocrinologist." Day after day, week after week, the staff wonders why clients just won't do what they are told. Handouts are given and verbal instructions are repeated time after time, yet no long-term compliance or success in changing their medical status is realized. Tis is a problem not for just FHC but for outpatient clinics nationally. Behavior change is not easy, and life-long habits are tough to reset, yet positive health outcomes rely on the incorporation of healthier behaviors.

1. Make a list of possible reasons for the six non-compliant behaviors noted in the passage above.