Costs to our healthcare system continue to climb each year as a result of nonadherence. The Express Scripts Drug Trend Report attributes $337.1 billion of waste in 2013 to nonadherence, up from $317.4 billion in 2012. Rather than treating the patient as a passive recipient of adherence messaging, it’s time to actively engage the patient in effective strategies that improve adherence and health outcomes.
Nurses’ Role in Adherence
Our adherence team at United BioSource Corp. (UBC), a subsidiary of Express Scripts, designed and executed an adherence program that included nurse case managers placing outbound calls to patients. On the initial outbound call, the nurse assessed the parity of the patient’s goals and the ability of the medication to help achieve that goal. The nurses helped set expectations to ensure that the patient knew what to expect and when.
Additionally, a risk assessment of behaviors and health history that might impact successful treatment was completed. The frequency and content of the outbound calls were driven by the outcome of the risk assessment. The program has increased long-term persistence on therapy from 35% to 85% at one year of treatment. Additionally, refills increased by 60%.
Redefining Adherence Programs
Adherence programs that engage patients as partners in therapy should include these four categories: goals, media, activation and relationship building. With these categories in mind, we redefine adherence programs and provide messaging that addresses patient and prescriber goals, using a medium that resonates with patients and engages them at their unique level of activation.
Aligning Physician and Patient Goals
Traditionally, the doctor’s goals for therapy were assumed to be the patient’s goals, and there was little discussion about what the patient wanted for an outcome. With healthcare reform, a new expectation has emerged that the patient is involved in decision-making and is fully informed about what options are available.
If a product is designed to stop progress of a disease, but not to treat the current symptoms, and a patient’s goal is to feel better, the misalignment between the product efficacy and the patient’s goal will probably lead to some nonadherence over time. Understanding the misalignment is critical to obtaining patient buy-in and providing individualized education.
Reaching the Patient
Individualized education can be provided through a number of formats such as mail, email, live phone calls by a nurse or pharmacist, auto-dialer calls, text messaging, push notifications, live chat or video calls. New means to reach patients continue to be created.
Because every patient responds differently to every type of media, it is important that a robust adherence solution provides options from which the patient can choose.
Patient activation refers to patients’ ability to manage their own health and healthcare. Activated patients are better able to articulate their barriers to success and can more easily identify interventions that will promote better healthcare behaviors. Patients who are less activated may need more assistance identifying their needs. Patient activation measurement tools have been tested and validated to help assess where a patient is in the spectrum of activation.
It’s time to actively engage the patient in effective strategies that improve adherence and health outcomes.
Finally, as we learn to partner better with patients, we need to learn a new vocabulary. Terms such as adherence, compliance and persistence are measurable standards that we use to assess outcomes. These words, however, resonate poorly with patients and are often understood as being “good” or “bad.” We need to learn how to express the ability for an individual to succeed with a therapy plan. And if the patient doesn’t succeed, we need to be able to express what part of the plan needs to be revised.
Building a sense of accountability with another person helps patients maintain progress toward meeting their healthcare goals. Because of the trust patients put in the nursing profession, nurses can more easily build the open, honest relationship needed to achieve a sense of accountability and help patients stay on track to meet health outcome goals.
Engaging well-informed patients in their healthcare decisions and gaining their commitment to treatment regimens is critical to solving the current healthcare dilemma. We need to open the door to communication with patients, and we need to continue to identify practical interventions to work in association with patients to help them meet their healthcare goals.
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