Strategies to Make Patients more Accountable for their own Health

by Ryan Sparks

As healthcare reform focuses on holding providers accountable for patient outcomes, how can providers encourage their patients to adopt better self-care behavior? In terms of patient involvement, most research has revealed low participation regarding compliance to a prescribed self-care regimen. This includes:

• Non-compliance with medication: Numerous studies have shown that patients with chronic conditions adhere to only 50-60% of medications as prescribed.
• Dismal follow-up: About 20% of patients don't follow up on their doctors’ referrals to specialists.(1)
• Non-adherence to changes in lifestyle: Exercise regimens are not followed by 41–58% of heart failure patients. Compliance with a sodium-restricted diet varies from 50% to 88% in heart failure patients.(2)

Lack of compliance with medications, delays in seeking medical attention, and failure to follow a recommended exercise and diet regimen are among the primary reasons for the high rate of rehospitalization among patients with chronic conditions. Providers considering joining an accountable care organization (ACO) and serving a specific patient population will need to consider a strategy for improving patient participation if they want to maximize their ROI. The following are some tactics that can get patients more involved in improving their own outcomes.

1. Start Early. Most research indicates the motivation to change one’s lifestyle is the strongest within 1 to 2 days after a surgical procedure. After 2 to 4 weeks, motivation declines and patients who do not feel pain (after successful surgery) may not be as motivated to change their behavior because they incorrectly view the surgical procedure as a cure rather than a treatment for chronic disease.

2. Ask Questions. Caregivers have better success when they couple questions with reminders when following up with their patients. For example, instead of staff just calling staff to remind their patients to do their exercises, they should also be asking the patients what specific exercises the patient is responsible for performing.

3. Educate with an Interdisciplinary Team. One study compared the readmission rates of patients that received education via a nurse educator; dietary and physical therapy consultations; routine telephone contact after discharge; and home visits from nurses trained in management of heart failure with those that received only “usual care”. The results indicated that hospital readmission rates were 4 times higher for patients that lacked the interdisciplinary education support. Additionally, the patients that did not receive interdisciplinary support required nearly 50% more skilled nursing care visits and more than twice as many home health aide visits. The study estimated a 6-week cost savings of $67,804 for the group that received the interdisciplinary education.

Self-care tactics such as these, along with technological and infrastructure policies, should be considered as part of a comprehensive strategy to maximize patient outcomes and ROI for a patient population.

References
1. Christopher B. Forrest, M.D., Ph.D., department of pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia; Albert Wu, M.D., professor, health policy and management, Johns Hopkins University Bloomberg School of Public Health, Baltimore; July/August 2007, Annals of Family Medicine
2. http://eurjhf.oxfordjournals.org/content/7/1/5.full