Adherence: Changing the way we interact with patients
*Diana Long, principal at DML Consulting, on how insights from the social sciences can be applied to patient compliance*
By on Nov 26, 2010Diana Long, principal at DML Consulting, on how insights from the social sciences can be applied to patient compliance
One of the problems with studying patient adherence is that we don't identify with the problem, says Diana Long, principal at DML Consulting.
To remedy the situation we have to change behaviors but she jokes, Most of us can't manage our own behavior and that of a small dog let alone get other people to change.
So Long focuses on how we can change the way we interact with other playerspatients, physicians, and regulatorsvia inputs from social scientists and linguistics experts.
Patients in the lead
Long suggests letting the main stakeholders, patients, take the lead.
This is a disruptive idea, she suggests, because it seeks to change the paradigm that has so far has prevailed for patient adherence improvement initiatives.
Whereas we see the 85% of patients who are not fully compliant as deviant, Longs suggests that what appears to be non-compliance may just be patients asserting control over their own behavior.
While the healthcare community is highly focused on baby boomers and the over-65s, Long sees adolescents as a demographic that needs to be considered.
These are the people who may well suffer from heart disease and mental health problems in their 30s, a lot sooner than their elders did.
Insight into the perspectives of these patients has been gained from studies in asthma among adolescents.
The drivers of adherence (and non-adherence) in this group include biological, cognitive, psychological, and social factors, all of which vary by age sub-groups.
The importance of patient-stakeholder groups
Long considers it vital to identify the patient-stakeholder groups, or dyads and triads, as she calls them.
Studies of the mother-child dyad, for example, have shown how a multidisciplinary adherence approach can be effective by exploiting personal as well as socio-economic factors.
We should not assume that the stereotypical family unit prevails today, Long cautions.
There are many types of family structures in society, and how these families make decisions will vary.
To maximize commitment to self-management, Long points out, patients need emotional as well as functional support.
She uses the example of rheumatoid arthritis, in which a patient who has not obtained relief from the condition will become more depressed and their mental state will mitigate against further compliance.
Long supports the use of interdisciplinary teams not just for individual expertise, but also to obtain a range of critical analysis.
A basic requirement to take action is knowledge, says Long. But knowledge alone is not enough.
People also need the confidence and skills necessary to act; many stressors, economic as well as social, affect peoples confidence and skills.
No silos, please
While categorizing patients is necessary to meet their needs, Long says, they should not be treated as silos.
Groups can learn a lot from each other, and it is also useful to compare experiences within different healthcare systems.
Long works on the basis of the 5 Cs: context, contact, content, channel, and continuity, and advocates starting with the end in mind.
Medical outcomes might be there, but what we are really driving towards is less absenteeism and less work impairment, she says.
Goals like these, Long concludes, enable patients to self-actualize and align themselves with the objectives of the healthcare system.
This article is adapted from a talk given at the 2009 Patient Adherence and Engagement Summit. To learn more about this years Patient Adherence and Relationship Marketing summit, June 16-17, click here