The well-known phrase, “God helps those who help themselves,” is commonly attributed to Benjamin Franklin but dates back to ancient Greece. In healthcare this idiom should be highlighted by every provider. I was recently in a discussion with a chief medical officer of a major healthcare system. One of his comments as we were concluding the meeting was, “If we can keep our congestive heart patients from opening a bag of potato chips when they get discharged from the hospital we will substantially reduce our readmission rate.” Our tendency to revert to prior behaviors is probably the most significant barrier to good health care outcomes. Herein lies one of the biggest issues in healthcare: the quandary of compliance, adherence, or simply following doctors orders.
“For most medical conditions, correct diagnosis and effective medical treatment are essential to a patient’s survival and quality of life. A significant barrier to effective medical treatment, however, is the patient’s failure to follow recommendations of his or her physician or other healthcare provider.” (“The Challenge of Patient Adherence.” Dove Medical Press Ltd 2005) Adherence has become even more complicated as there have been significant pharmaceutical breakthroughs resulting in patients frequently being prescribed numerous drugs to be taken on a daily basis. The statistics indicate that the greater number of prescribed drugs, the lower the rate of adherence. One study noted a patient taking 13 or more pills per day has an adherence rate of, at best, 20%.
People often joke about purchasing exercise equipment that they use to hang their clothes on. This is confirmed as the adherence rate of suggested lifestyle changes such as exercise is less than 20%. Further, only about 35% of patients who are prescribed physical therapy follow through with the program.
The growing important of health literacy plays an outsized role in the need for better physician/patient relationships. Communication between provider and patient is a critical factor in establishing follow-through in compliance with physician recommendations. When we sit in a physician’s exam room, we often experience a very busy physician trying to prescribe and educate us while they are pressured by time constraints. This inherent tension does much to break the trust bond between the physician and the patient. A good portion of what is conveyed is either misunderstood or forgotten. One study in the Dove article indicates that 56% of the instructions are forgotten immediately upon the patient leaving the physician’s office.
Ageism, depression and psychological disorders also play very big roles in adherence. Each of these have a significant psychological impact on the patient and not given sufficient attention in the treatment process. We are just beginning to understand the impact of state of mind on physical health care outcomes. The likelihood of adherence declines substantially if these are not considered in the evaluation of an appropriate treatment plan.
Ironically, the COVID-19 pandemic has accelerated our need to focus on the solutions to the adherence dilemma. As more information comes to light about the post COVID-19 syndrome we are learning about the impact it is going to have on healthcare compliance and recovery. What has evolved is a sea change in delivery of care through tele-health. While this is not the subject of this article it is going to be a critical factor in increasing adherence. Physicians are discovering that patients relaxed in their homes are understanding the treatment plans. Further, patient access to health navigation expertise, provided by companies like Curus provides the patient with someone who has their back in the healthcare process.
At Curus, for example, we provide a 7/24/365 nurses line to give our members the peace of mind and answer questions about physician instructions, drug interactions, etc. Statistics have shown that 74% of all medical inquiries can be handled by a nurse.
Through changing technologies, home monitoring, and access to 24-hour nurse lines the ability to increase adherence is now at hand. If we utilize these advances, which have been accelerated by a decade as a result of COVID-19, we will improve the quality of healthcare and give the patient greater ownership of the process. They will be less tempted to head for the potato chips when they are discharged from the hospital because of the encouragement and direction they are receiving beyond the physician’s office.