A new look at patient communications in outcomes-driven healthcare

Susan Carr

Chandler Chicco Companies

Susan Carr discusses the problem of patient adherence. She highlights the importance of effectively communicating patient self-management techniques to tackle the problem.

Around the world, healthcare markets are changing rapidly as patients, healthcare providers and payers demand lower costs, higher quality care and better health outcomes. In this environment, pharmaceutical companies must increasingly demonstrate not only that a drug works in the traditional sense, but also that it delivers improved patient outcomes that lessen burden of disease and costs to the system.

In this new world, pharmaceutical companies need to tap into a deeper understanding of patients and develop more consultative relationships with healthcare providers to understand the factors beyond product safety and efficacy that influence treatment success or failure such as medication adherence and the ability of patients to make behavioral changes and self-manage their health conditions.

To be or not to be adherent

Despite all the money, time and effort that pharmaceutical companies have poured into educating physicians and patients about their products, medication adherence is still a huge and costly problem that not only affects the bottom line but also impacts the ability to achieve and demonstrate improved patient outcomes.

• Half of all patients stop their therapy within the first six months.

• One-fifth of all prescriptions are never even filled.

Most adherence problems are not the unintentional, “I forgot” variety. Most non-adherent patients purposefully decide not to take medications based on their attitudes and beliefs about many things including whether they really need a certain treatment, or whether its risks or side effects outweigh its benefits. Motivating behavior change requires developing solutions that address patient needs in the context of those attitudes and beliefs.

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“…pharmaceutical companies need to tap into a deeper understanding of patients…”

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Making patient empowerment real

Not only do patients decide whether or not they will adhere to a medication regimen, in fact, most decisions determining outcomes are made by the patient, not the physician, especially with regard to chronic diseases. Patients are the ones who decide whether to exercise, what to eat, if and when to take their medications. It’s estimated that up to 99% of chronic care is done by the person who has the illness.

Now, consider this in context with the ever-expanding burden of chronic disease on healthcare systems worldwide:

• According to the World Health Organization, as much as 75% of the healthcare resources of developed countries are consumed by the needs of those with chronic conditions.

• The Centers for Disease Control estimate that chronic diseases now account for 60% of 58 million deaths globally each year.

A more collaborative model is needed in which patients are educated and empowered with problem-solving skills to take an active role in their own healthcare. This requires patient-centered approaches that:

• Acknowledge patients are the experts in their own lives,

• Encourage patients to identify the health issues and treatment goals that are most important to them, and

• Support patients in taking an active role in deciding what they will do to achieve those goals.

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“One-fifth of all prescriptions are never even filled.”

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Self-management education is directed to improving patients’ ability to manage the symptoms, treatment, physical and psychosocial consequences inherent in living with a chronic condition. Evidence from controlled clinical trials suggests that self-management education is more effective than information-only programs for improving patient outcomes.

For pharmaceutical companies, effectively communicating with patients about self-management means acknowledging that the doctor’s prescription is only one point in the journey and approaching disease management from a more holistic (“beyond the pill”) perspective.

It also requires encouraging and facilitating a more patient-centric and collaborative approach to care. Health communicators are uniquely positioned to help improve outcomes by facilitating this new type of HCP-patient interaction while helping patients be more effective stewards of their own health and wellness.

Harnessing the power of digital technologies

The ability of patients to self-manage their conditions also is benefiting from the expanding array of tools and technology available to patients and caregivers:

• Smartphone apps to empower patients with increased control over disease management,

• Online personal care plans to facilitate care coordination,

• Interactive diaries to track diet, exercise, nutrition and medical interventions and charting progress,

• Web-based intervention programs to facilitate on-line self-monitoring and individualized feedback.

According to a Manhattan Research survey, 169 million U.S. adults, representing 72% of the adult population, went online for health information in 2010. Ninety-nine million Americans have done one of the following activities as a result of the information or tools they found online:

• Challenged their doctor’s treatment or diagnosis,

• Asked their doctor to change their treatment,

• Discussed information found online at a doctor appointment,

• Used the Internet instead of going to the doctor, made a healthcare decision.

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“Consumers 55 years old and older are showing the strongest e-growth in recent years.”

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Another (perhaps counterintuitive) trend fueling adoption of health information technology is the aging of the population. While it may be true that many elderly patients today may be less able or inclined to engage with digital media, the aging boomer generation right behind them is certainly comfortable with digital media for accomplishing a range of health information-related tasks, as are their children caregivers. In fact, according to Manhattan Research:

• Consumers 55 years old and older are showing the strongest e-growth in recent years.

• The share of consumers 65 years old and older who are going online for health doubled between 2006 and 2010.

These technologies are facilitating our ability to reach people where they live, work and play. It has the potential to bring patients and providers together in new ways. With smartphone and tablet apps health education information can be delivered in creative and dramatic formats that elevate the patient learning experience. Digital and social media technologies can facilitate the shift that needs to take place from “one size fits all” to personally relevant communication – the most persuasive kind.

What counts most

What counts most, of course, is whether the content and utility of what is provided truly increases understanding and improves outcomes. Substantive change at this level requires working toward a deep understanding of what motivates patients and consumers in their healthcare behaviors and what meaning they ascribe to their experiences. It requires taking a more holistic view of the patient journey to engage at multiple stages along the continuum of care, from diagnosis, therapy initiation and adherence, to quality of life and outcomes assessment. Only then can we be certain that we are communicating in ways that are providing patients what they need to understand and manage their health in today’s outcomes-driven healthcare environment.

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About the author:

Susan Carr is a senior writer and strategic counsel for Chandler Chicco Companies, a global health communications group that delivers integrated counsel and expert insight from a variety of strategic perspectives. Her work for major pharmaceutical companies and other health care organizations has included everything from disease awareness and patient education programs, medical education, market development and new product launches, to issues management, corporate communications and public policy initiatives.

How can pharmaceutical companies effectively communicate self-management techniques to patients?