For any of us, a visit to the doctor can cause anxiety. Our fear of pain, discomfort, or simply the unknown can sometimes overshadow our appreciation of medical care in helping us live the healthiest, happiest lives possible. For people with intellectual and/or developmental disabilities (I/DD), who may have more difficulty understanding the importance of health care and the rationality of medical procedures, anxiety can create significant obstacles to physical well-being and overall quality of life.

To eliminate these barriers and to empower patients with I/DD to play an active role in maintaining good health, professionals at Premier HealthCare (Premier) are utilizing desensitization to reduce fear, minimize discomfort and complete clinical procedures, with encouraging results.

Good Health, Step by Step

Dr. Beth Diviney, a behavior analyst, and Dr. Chrystalla Orthodoxou, a senior dentist at Premier, were early collaborators in promoting the use of desensitization techniques in dental care. Since then, several of our nursing and other healthcare professionals have effectively used this approach in a variety of clinical settings.

Desensitization techniques combined with other strategies are implemented to reduce the fears that patients experience during medical and dental appointments and, ultimately, enhance their adherence to the treatment designed to improve physical health, self-esteem and general well-being. This is a planned approach that entails breaking down the appointment into steps that can translate into increments of exposure to whatever causes anxiety. At Premier, that gradual exposure begins the moment an individual enters one of our waiting rooms, where our clinical staff is highly visible, interacting with colleagues and patients.

An important next step is identifying what causes anxiety. Each patient is unique, and while one may fear injections, another might be anxious about a dentist’s drill. Tolerance also varies. One patient may be able to participate in a visit until they see a needle, another might not be comfortable getting into the dental chair. The staff at Premier take the time to observe and listen to our patients, in order to understand their specific situation, help them overcome their fear, and successfully complete the necessary clinical procedures.

Once the staff member has an understanding of what may be causing a patient anxiety, he or she can adjust the goals and instructional strategies of each visit –- being able to look at a needle, or to sit in the dental chair –- to ensure incremental comfort and success.

Follow-up visits to complete next steps are scheduled to effectively build upon past accomplishments and, when appropriate, practice or homework is assigned. During these visits, staff selects a combination of learning techniques to empower patients and to make their visit a positive experience. Some of these techniques may include:

• Tell-Show-Do –- briefly describe, demonstrate and then act accordingly;
• Exercise Control –- patient uses a signal to start, stop and/or continue a step;
• Modeling –- whereby a peer or family member completes a step first;
• Praise and recognition of incremental success;
• Distraction and relaxation through music, toys, counting, etc.;
• Offering choices and making simple requests during his or her treatment.

By using these strategies, Premier staff members build trust with patients and enable them to be part of the health care process.

Long Term Investment, Many Rewards

Further development of a desensitization program at Premier will enable us to help many of our patients develop a positive approach to medical visits, as well as better health. It has enhanced the quality of life for some of our patients, including children no longer excluded from activities like summer camp due to fear of having a required blood test. With others, it has obviated the need to receive anesthesia for routine care.

Recently, we conducted a survey to assess the number of patients who have been, or are likely to be, resistant to certain clinical procedures (e.g., injections, phlebotomy, physical examination, dental care, etc.), and as such would potentially benefit from a desensitization program. Not surprisingly, our clinicians reported that at least one-third of our patients would greatly benefit from such a program. However, implementing desensitization strategies requires time, patience and money. Resources are limited. As we move forward in fulfilling our commitment to providing our patients with the highest quality of care, we’re dedicated to seeking grants and other ways to formalize our desensitization program. Developing and implementing such a program on a (much-needed) larger scale will take a strong commitment from all directly and indirectly involved. It also requires a belief in our patients’ ability to learn and change their behavior to reap long-term benefits.

The good news is that today individuals are more educated than ever about their health and aware of the importance of preventive care. Many people are committed to taking steps now to maintain good health and avoid future problems and the need for more extensive care.

Desensitization, with its focus on enabling our patients to be comfortable going to see doctors and on facilitating regular visits, is a valuable method of providing preventive care and an opportunity for patients to develop more autonomy over their care. It is one of the many ways that we have been effective in enhancing our patients’ health and well being, and we look forward to building on our success.

November 2005

By Kathryn Butvick, Ph.D.
Nurse Adminisrator, Premier HealthCare