Are doctors the forgotten factor in improving patient adherence?
Doctors almost seem to be the forgotten player in the healthcare system — perhaps it’s because of the perception that doctors are just pawns of the pharmaceutical industry. For example, there has been a steady stream of news about doctors refusing to see pharmaceutical sales reps and cutting financial ties with pharmaceuticals.
Or, perhaps it’s because of the death of the doctor-patient relationship. As was lamented in a recent LA Times article:
The true doctor-patient relationship has been on the wane since the house call went the way of the carrier pigeon.
Moreover, this disruption in the doctor-patient relationship was evidenced in a recent survey. 257 physicians were polled and none of them kept track of their patients’ compliance rates. Although this finding is sad, this is unfortunately understandable given how medicine is currently practiced and doctors are reimbursed (i.e. paid). In short, doctors are not paid to spend time guiding patients.
But, here’s the interesting part — the researchers took 300 “clients” (which I take to mean patients) and divided them into two groups in a commercial weight loss program:
Group 1 — 150 clients received individualized, 15-minute sessions each week during which they were weighed and measured and discussed menu choices for the following week; and
Group 2 — 150 clients received a 6-minute interview on their first day. From that point onward, each client received the same process as Group 1 with 1 exception: Group 2 clients were reminded each week of the responses they gave during their initial interview.
The result — “It turns out that patient compliance is directly influenced by the degree to which clinicians intervene on behalf of the patient … only 32% of Group 1 achieved and maintained their weight loss goals for 12 months compared with 84% of Group 2.”
What this study implies is that adherence programs need to be more than just physician “helpers” — for example, reminders and rewards. They need to engage physicians to begin and close the treatment loop.
Boxcutters Gem #1131 – Engage physicians to begin and close the treatment loop.
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Elisabeth, college psychiatrists…
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boxcuttersinc 
Clearly there are providers who believe that the pharmaceutical industry is the devil and have no part in the care process, Personally I find that attitude mystifying considering where would medicine be without the pharmaceuticals that are produced by probably the one industry outside of defense/aerospace where America leads the world. If Pharmaceutical adherence programs are used correctly, then they are an invaluable asset to a professional that seems to be not following up on medication adherence. If we can find a middle ground between the pharmaceutical and medical profession then the patient can only benefit.
@dialdoctors comments:
“Drs can help w/ adherence unfortunately not everyone can take the time bc the system doesn’t help. Good intentions go so far”
You raise interesting points, Chris. Customers always want to know the value of the product. For drugs, pharma can add value to doctors by providing them help with adherence, and not always trying to constantly trying to do product promotion. Thoughts?
I really enjoyed this post! I think it is totally on the right track in showing empirically the importance of the healthcare professional – client relationship as a powerful mechanism of change. They need to do a follow-up to rule out that it wasn’t just getting extra face time and that it wasn’t being given comparative information that caused the effect. My guess is that the effect was probably real. There is other research showing antidepressants prescribed by a psychiatrist work better than those prescribed by a regular dr, perhaps because of the relationship. Also, psychotherapy research has shown the therapeutic relationship effects change independent of therapist’s method.
This would be lovely, but I think it’s a time issue.
Even though doctors don’t spend a great deal of time with patients, it’s more than many other countries do who have socialized medicine.
For example, in Japan, although people go the doctor very frequently, they see the physician for less than 3 minutes. It’s incredibly strict, and sometimes timed.
In case you’re interested in the 3 minute Japanese stat referred to by The Nerdy Nurse, it came from the Frontline PBS documentary called “Sick Around the World” — http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
While less than 3 minutes with a doc may seem outraeously little, Frontline also tells us that it works — “The Japanese go to the doctor three times as often as Americans, have more than twice as many MRI scans, use more drugs, and spend more days in the hospital. Yet Japan spends about half as much on health care per capita as the United States.”
I would encourage reading the documentary, because it details how different countries have handled delivery of healthcare.
This problem has existed for many years. I see the issues as:
1. Greater pressures placed on Doctors with busy workloads
2. A lot of Doctors not leveraging technology to drive efficiency (this is slowly changing)
3. Pharma companies under amazing pressure not to sell/market/promote to patients for fear of legal retribution by the ambulance chasers
In creating my business http://www.Patient-Reminders.com we wanted to help solve the patient compliance, adherence and retention issues with an easy to use patient alerts and reminders messaging hub that:
1. Sends relevant, highly personalized messages as if from the Doctor with mail merge content
2. Messages arrive at the optimal time – meaning the message becomes useful
3. It had to be highly affordable, easy to adopt and deploy in hours not days or weeks and could be used by almost anyone.
With the system, we are seeing tremendous rates of patient compliance, medication adherence and retention. In clinical trials engaged patients closely adhere to the clinical study protocol.
It’s really easy to automate patient follow-up with the http://www.patient-reminders.com platform.
I would be delighted to arrange a video web demo.
Bernie
Bernie Thomas – http://www.Patient-Reminders.com
Bernie@patient-reminders.com