Strategies to Improve Patient Adherence to Treatment
Strategies to Improve Patient Adherence to Treatment
The health belief model is a useful framework when discussing patient adherence; however, one of its limitations is that it does not emphasize the role of external factors such as family employment, access to care, and socioeconomic status. These external factors can be more challenging to address and require more involved solutions that do not fit within the scope of this article.
Lack of time is a challenge that physicians face when seeing patients. Limited time during office visits can make it challenging to address patient adherence issues. Most of the strategies discussed in this article are not time consuming; however, they may require an initial time investment to set up or organize. For instance, patient education is an important strategy in improving adherence that can be achieved through the use of supplemental informational brochures, specific educational Web sites, or relevant YouTube videos. Selecting and gathering the right materials will require some initial time and effort; however, once that has been accomplished, patient educational materials can be distributed easily and efficiently. Another strategy discussed was providing patients with written instructions that summarize the treatment plan. EMRs have simplified this task because clinicians can use "smart" phrases to generate a list of pretyped instructions for common treatments that can then be printed and given to patients. Reducing the time interval between office visits was another strategy discussed to help improve adherence. By seeing patients earlier in their treatment, physicians can improve adherence to medication, reducing the need for additional follow-up visits and saving time in the long run.
In this article we have focused mainly on the role of physicians in improving adherence; however, physicians are not the only stakeholders who are invested and interested in adherence-improving programs. As depicted in Table 4, nurses, nutritionists, health insurance companies, employers, pharmaceutical companies, and pharmacists are directly affected by patient adherence. In general, nurses spend the most time with patients and can play a significant role in further educating patients and answering questions. Patients struggling with weight loss may benefit from consulting a nutritionist who can help design a diet plan that is tailored to each individual and provides easier adherence.
The estimated cost of nonadherence is considerable and is surely a point of interest for health insurance companies and employers. The trend in health care seems to incentivize better health behaviors, such as not smoking and weight loss; this concept could be applied to help improve patients' adherence. The trend to link physician compensation with patient outcomes also may make patient adherence a more salient concern for physicians.
Some employers have begun implementing workplace wellness programs that are designed to increase health awareness. These programs vary widely; however, they may include personalized health coaching and incentives such as reduced insurance premiums for weight loss and lowered blood pressure. Some employers also are enforcing consequences for poor health behaviors such as smoking and increased body mass index. This growing culture of health awareness in the workplace and provision of incentives for improvement in blood pressure, blood sugar, and cholesterol can help further reinforce patient adherence.
Pharmaceutical companies also are highly interested in the adherence dialog. Their revenue is tied directly to patients filling prescriptions. Furthermore, these companies tend to have research and development divisions that rely on patient adherence in clinical trials to assess new products. Pharmacies share pharmaceutical companies' incentive for patient adherence, and pharmacists, like physicians, have direct patient contact and can play a role in improving adherence through addressing patient concerns, questions, and uncertainties regarding medication consumption. Pharmacists can simplify dosing regimens, inquire about adverse effects, use combination drugs when appropriate, and educate patients about disease processes as well as lifestyle changes. In addition, they can provide information to patients on copay assistance programs and synchronize all of a patient's prescription refills for the same day, an action that has been shown to improve adherence.
Discussion
The health belief model is a useful framework when discussing patient adherence; however, one of its limitations is that it does not emphasize the role of external factors such as family employment, access to care, and socioeconomic status. These external factors can be more challenging to address and require more involved solutions that do not fit within the scope of this article.
Lack of time is a challenge that physicians face when seeing patients. Limited time during office visits can make it challenging to address patient adherence issues. Most of the strategies discussed in this article are not time consuming; however, they may require an initial time investment to set up or organize. For instance, patient education is an important strategy in improving adherence that can be achieved through the use of supplemental informational brochures, specific educational Web sites, or relevant YouTube videos. Selecting and gathering the right materials will require some initial time and effort; however, once that has been accomplished, patient educational materials can be distributed easily and efficiently. Another strategy discussed was providing patients with written instructions that summarize the treatment plan. EMRs have simplified this task because clinicians can use "smart" phrases to generate a list of pretyped instructions for common treatments that can then be printed and given to patients. Reducing the time interval between office visits was another strategy discussed to help improve adherence. By seeing patients earlier in their treatment, physicians can improve adherence to medication, reducing the need for additional follow-up visits and saving time in the long run.
In this article we have focused mainly on the role of physicians in improving adherence; however, physicians are not the only stakeholders who are invested and interested in adherence-improving programs. As depicted in Table 4, nurses, nutritionists, health insurance companies, employers, pharmaceutical companies, and pharmacists are directly affected by patient adherence. In general, nurses spend the most time with patients and can play a significant role in further educating patients and answering questions. Patients struggling with weight loss may benefit from consulting a nutritionist who can help design a diet plan that is tailored to each individual and provides easier adherence.
The estimated cost of nonadherence is considerable and is surely a point of interest for health insurance companies and employers. The trend in health care seems to incentivize better health behaviors, such as not smoking and weight loss; this concept could be applied to help improve patients' adherence. The trend to link physician compensation with patient outcomes also may make patient adherence a more salient concern for physicians.
Some employers have begun implementing workplace wellness programs that are designed to increase health awareness. These programs vary widely; however, they may include personalized health coaching and incentives such as reduced insurance premiums for weight loss and lowered blood pressure. Some employers also are enforcing consequences for poor health behaviors such as smoking and increased body mass index. This growing culture of health awareness in the workplace and provision of incentives for improvement in blood pressure, blood sugar, and cholesterol can help further reinforce patient adherence.
Pharmaceutical companies also are highly interested in the adherence dialog. Their revenue is tied directly to patients filling prescriptions. Furthermore, these companies tend to have research and development divisions that rely on patient adherence in clinical trials to assess new products. Pharmacies share pharmaceutical companies' incentive for patient adherence, and pharmacists, like physicians, have direct patient contact and can play a role in improving adherence through addressing patient concerns, questions, and uncertainties regarding medication consumption. Pharmacists can simplify dosing regimens, inquire about adverse effects, use combination drugs when appropriate, and educate patients about disease processes as well as lifestyle changes. In addition, they can provide information to patients on copay assistance programs and synchronize all of a patient's prescription refills for the same day, an action that has been shown to improve adherence.
