Monthly Archives: April 2014

7 Reasons HCPs Should Work Harder at Optimizing Adherence

Optimizing adherence has positive impacts on many aspects of healthcare, including outcomes, quality, and costs. When taken all together, these impacts provide clear incentives for HCPs to work harder to achieve better adherence.

Optimizing Adherence and Outcomes of Care

Many of you I’m sure are familiar with the ‘Physician Charter’, published in Annals of Internal Medicine in 2002 (see here). This multinational consensus drew on both European and U.S. expertise to create a set of 10 commitments. These commitments restate professional responsibilities in the context of challenges for the new millennium.

As a scene-setter for this post, I’ll focus on the commitment #5 from this ‘Charter’, which addresses quality of care. The essence of this commitment for physicians (and other HCPs) is as follows:

Work collaboratively with other professionals to reduce medical error, increase patient safety, minimize overuse of health care resources, and optimize the outcomes of care.”

(The emphasis above on outcomes of care is mine.)

There are many potential paths for achieving better outcomes. For the moment though, I’d like to address just one of them: to propose why HCPs should work harder at optimizing adherence.

7 Benefits of Extra Focus on Optimizing Adherence

Optimizing adherence has positive impacts on many aspects of healthcare; impacts that underline the importance of working harder to achieve better adherence.For patients with chronic conditions, optimizing adherence can significantly help in achievement improved care. Here are reasons why HCPs should focus more on this approach.

1.     Improved Treatment Success

When patients take medications as prescribed, the chances of treatment success (eg, lowering BP, reducing HbA1c levels) are markedly improved. This is not only good for the patient but also good for the HCP …

2.     Increased HCP Satisfaction

For HCPs, feelings of personal satisfaction can be elusive. Investing effort in optimizing adherence not only pays back in terms of improved treatment success. It can also pay back in terms of the increased sense of satisfaction HCPs may feel from a job well and fully done.

3.     Reduced Healthcare Costs

The pressures to control rising healthcare costs are huge. In a recent report (see here), the increased healthcare costs associated with non-adherence in the U.S. were estimated at $290 billion. Increased focus on optimizing adherence can help curb these extra costs, while also improving treatment success and increasing satisfaction. A win, win, win!

4.     Taking Responsibility for Adherence

It has been suggested (see here) that physicians see patients as being primarily responsible for adherence. In everyday practice though, patients need HCP help to get them on the right track. This is especially so when patients have motivational issues that undermine their intent to adhere. Optimizing adherence is shared responsibility between the patient and HCP. It’s vital however that the HCP steps up to take on his or her adherence responsibility to get things moving.

5.     Achieving HCP Rewards for Quality

As time moves forward, more emphasis will be placed on the ‘quality of care’ provided, as opposed to ‘quantity of care’. The exact measures of ‘quality’ will likely evolve over time, but will surely include components relating to outcomes and patient satisfaction. Outcomes are positively influenced by adherence. So there’s a direct relationship between adherence and quality; greater investment in the former can influence greater rewards through the latter.

6.     Adherence Tools Are Readily Available

To help HCPs in optimizing adherence, many different tools are available. These range from reminder apps for mobile phones, to web sites that engage and educate patients, to HCP training programs that help improve communication with patient and can also help in building patient motivation to adhere. These tools can work in concert with practice efforts to increase patient commitment to adhere.

7.     Better Treatment Outcomes

“Drugs don’t work in patients who don’t take them.”
C. Everett Koop

Physicians put a lot of effort and care into making the right diagnoses and prescribing the right treatments. But all that care is for nothing if patients don’t adhere. Investing a little more time to motivate and support the patient to adhere to treatment carries as much importance as the initial diagnosis and treatment choice. Only when medications are taken correctly and consistently over time will better patient outcomes be achieved.

The roles of physicians and other HCPs in fulfilling this vision are paramount.

HCP Solutions to Poor Adherence: Should Logic or Emotion Be the Focus?

When HCPs address issues of poor adherence with their patients, where should their focus lie? Should it be more on logic or on emotion? Here are a few thoughts about why emotion should be front-of-mind.

Two recent publications got me thinking again about the roles of emotion and logic in adherence-related decisions. This time from the HCP perspective.

HCPs Show Poor Adherence to Treatment Guidelines

A report from the Dartmouth Institute (see here) examined variations in prescription use for Part D patients across the U.S.A. Data for the report came from a 40% random patient sample for years 2006 to 2010. For analysis, the authors divided medications into three classes:

  • Effective – those with evidence of benefit
  • Discretionary – those of uncertain benefit
  • Harmful – those where risks outweighed benefit

In summary, the analysis found wide regional variations in prescription use. It also found:

  • Lower than optimal use of effective meds
  • Common use of discretionary meds
  • Higher than expected use of harmful meds

These wide regional variations together with sub-optimal usage of medications suggest poor adherence by prescribers to guidelines. But what causes this poor adherence?

When deciding how to address issues of poor adherence, should HCPs focus more on logic or emotion? Here's why emotion should take priority.What Drives Poor Adherence by HCPs?

Some answers to this question can be found in a Medscape article (see here).

The article commented that despite efforts to promote evidence-based guidelines, often these are not applied. Some 30%-40% of patients do not do receive care according to present scientific evidence, while 20%–25% of care provided is not needed or potentially harmful.

The paper concluded that poor adherence to guidelines was associated with doctors’ subjective characteristics. Doctor attitudes, beliefs, experiences, knowledge, skills, and values were all cited as playing fundamental roles.

So doctors tend to go with what they feel, not what someone else tells them. Perhaps sounds familiar? It’s just like patient reasons for non-adherence to medications – driven more by emotion (ie, feelings, experiences, and beliefs) than by logic.

Which leads me back to my last post (see here) and the roles of emotion and logic in decision-making. This suggested that:

  • Emotion has a major role in decisions
  • Emotion tends to take the lead in decision-making
  • Logic is then used as post hoc rationalization

So if emotion leads, how does this affect the way HCPs should go about improving poor adherence?

Applying Emotional Approaches to Poor Adherence

We’ve all been in situations where we’ve delivered a bulletproof, rational proposal. One that was so solid, there was no way it could be turned down. But then the other person says “no” and rejects our arguments. He or she just wasn’t swayed by our logic.

That’s because decision-making isn’t logical, it’s emotional.

A major slice of patient non-adherence is intentional. They choose to be non-adherent. These patients override rational arguments with emotional feelings, beliefs, and personal experiences. Just as doctors may do when choosing not to follow treatment guidelines.

Bombarding these patients with more facts and more logic is unlikely to win the day. HCPs need to communicate at a more personal, emotive level.

Spend a little time. Engage with these patients. All with the aim of discovering internal motivators that can be used to improve adherence. Maybe something they care a lot about, or something they want to achieve? Or maybe something “fun” that gets them away from negative thoughts associated with their condition?

Something they care enough about that they’re prepared to adhere to treatment to get there.

There are approaches available that can help HCPs do this (see here and here).