3 Ways to Improve Post-Treatment Compliance

text post treatment compliance

According to a study published in the Journal of the Royal Society of Medicine, patients tend to immediately forget 40-80% of information their care providers present to them – or, worse, remember incorrect information about care plans or follow-up care.1  In the era of value-based care, it’s important to find a way to ensure patient compliance with treatments to improve patient outcomes and avoid costly readmissions.

Engaging patients with messages and reminders sent as text messages offers healthcare professionals an opportunity to improve patient treatment compliance when, where, and how it would be most effective.

Treatment Plan Communication

Traditional approaches to care plan compliance include verbal discharge instructions and sending patients home with discharge documents and information. Digital interventions can improve compliance with care plans, including:

  • Providing a digital format of care plan information that can be referred to anytime, anywhere
  • Clear, action-oriented reminders of care plan instructions when and where they are needed during the recovery process. For example, if a patient is to begin an exercise regime on day 3, a reminder can be sent that morning with a link to specific instructions or videos walking patients through the exercise program.
  • Provide timely guidance, tips, or exercise recommendations to support patient self-care

Handling some of this important patient information via text message can support the care plan at precisely the right time while also keeping the lines of communication open so that patients can text back or call in if they have any questions or need further information.

Automated Medication Adherence Reminders

Medication adherence requires that patients fill their prescriptions, understand directions, and take medication on time. Adherence rates for chronic conditions is about 50%, accounting for up to half of treatment failures and 25% of hospitalizations each year.2 Adherence interventions strategies for medication includes directly faxing prescriptions to pharmacies and leveraging reminders and single-response survey questions (“Have you picked up your prescription from the pharmacy?”).

Text messaging doubled the odds of medication and improved overall adherence rates by 17.8%3

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Although there are many digital adherence technologies (DATs) that can automate reminders for medication, it’s important to support ongoing two-way engagement with patients, who may have questions or concerns about side effects, and to have a way to send survey questions to confirm compliance.

Surveys to Improve Compliance and Reduce Readmissions

In a recent survey, Dr. Ethan Basch, M.D., M.Sc., found that nearly half the physical and psychological symptoms of his patients went unreported.4 Improving patient outcomes requires capturing more patient-reported outcomes (PROs) in real-time to provide timely interventions.

After discharge and periodically through recovery, you can leverage automatic procedure-specific diagnostic surveys to assess progress and ensure understanding of the treatment plan. Patient-reported outcomes can be tailored to the condition or procedure in question, assessing general health as well as data specific to symptoms, side effects, or pain levels. For the management of chronic diseases such as diabetes, our own data suggests that securely surveying key health indicators can help improve a1c rates by 0.5 points or more.

Based upon patient responses and your defined rules, PerfectServe’s patient engagement platform will alert care team members if a patient requires follow-up. Based upon the familiarity and simplicity of text messages, the solution has the proven capability to reduce readmissions by as much as 30%.

“We have such a hard time getting some patients to answer a phone call, yet they will respond to assessments delivered by text. PerfectServe saves valuable time for our nurses every day and helps us reach those in need more quickly.” — Karen Loscheider, Manager, Triage Nurse, Park Nicollet Health Services

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In addition to encouraging patient reported outcomes, patient satisfaction insight surveys also help you gather and act upon feedback in time to make a difference on a patient’s overall satisfaction, which can help reduce the risk of patient leakage and improve HCAHPS scores.

PerfectServe’s Patient & Family Communication solution can help you deliver a thoughtful, targeted set of prompts to support post-treatment care to reduce readmissions and improve outcomes. Our solution is proven and is live in more than 10,000 care locations, facilitating more than 42,000 patient interactions every day.

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1 Roy P C Kessels, PhD. “Patients’ memory for medical information,” Journal of the Royal Society of Medicine. 2003.

2 Jennifer Kim, PharmD, BCPS, BCACP, CPP et al, “Medication Adherence: The Elephant in the Room,” US Pharmacist, 2018.

3 Thakkar J, Kurup R, Laba TL, et al. “Mobile telephone text messaging for medication adherence in chronic disease: a meta-analysis.” JAMA Intern Med. 2016

4 Ethan Basch, Md, MSc, et al. “Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment,” JAMA, 2017

4 reasons why patient education should be a priority

physician patient education

As providers continue to evolve away from fee-for-service healthcare and towards a value-based care system, patient education is becoming more important than ever.

Value-based healthcare’s focus on outcomes and, consequently, what happens outside the “four walls” of the healthcare organization, requires a renewed focus on patient education to help combat chronic illnesses, increase preventative care, reduce readmissions and lower expenses.

When it comes down to it, an informed patient who understands their condition and corresponding treatment plan is one of the most important factors in achieving the goals of value-based healthcare.

Here are four reasons why patient education should be a strategic priority for healthcare organizations across the nation.

Reimbursements

Last year, the U.S. Department of Health and Human Services (HSS) noted that by 2018, 50 percent of all Medicare reimbursements should be tied to value-based care. The HSS also wants value-based reimbursements for 2016 to come to 30 percent—in other words, the HSS plans for healthcare organizations throughout the country to begin transitioning away from fee-for-service and towards value-based care.

With the traditional fee-for-service model, providers received compensation based on volume: they’d see as many patients as possible, and order tests and procedures without regard to cost. With value-based care, alternatively, providers will begin to focus more so on evidence-based medicine, preventative and tailored treatments, and, of course, patient education, in order to increase quality of care while also keeping expenses down.

Increasing patient education efforts through social media campaigns, text-based outreach platforms, informative web videos, email marketing, podcasts, community lectures, and brochures are examples of inexpensive means for a provider to adapt to the new value-based model without having to completely restructure their organization.

Preventing chronic illness

Back in 2012, roughly half of American adults—or approximately 117 million people—were diagnosed with one or more chronic illnesses or health conditions. In fact, that year, one out of every four adults had two or more chronic conditions.

Currently, approximately 133 million Americans suffer from one or more chronic illnesses like diabetes, depression, or asthma—and the numbers are only increasing. Seventy to 80 percent of total health care costs are directly tied to the treatment of chronic illnesses. In short, the treatment of chronic illnesses is a major concern for the American medical community.

One of the most successful means of combating chronic illnesses is through patient education. Certain diseases, such as diabetes, can’t be treated through medical attention alone; patients require self-management, such as proper diet, to treat these illnesses as well. Studies have shown that patient education delivers results.

review of over 40 studies on diabetes patients noted that when providers encouraged “patient-oriented interventions,” patients’ health improved, and some even established positive glycemic control. Patient education should be viewed as a strategic weapon in the fight against the progression of chronic diseases in the United States.

Reducing costs

Unnecessary patient readmission is a costly issue that currently plagues our nation’s healthcare system. In fact, it’s estimated that these readmissions cost the U.S. government roughly $17 billion each year.

Additionally, it’s estimated that one out of every five Medicare patients will be readmitted into a hospital within a month following treatment. Readmissions, either due to over-cautiousness, carelessness, or patients relapsing, are a sizable expense that healthcare providers need to avoid.

But how can providers cut down on readmissions while also avoiding additional expenses?

Patient education can help providers to inform patients on the proper self-managed care needed to avoid readmissions. Additionally, with increased patient education efforts, providers can help patients understand the care setting most appropriate for their condition.

Uninformed patients sometimes seek treatment in the Emergency Room (ER) for minor issues when an Urgent Care Center, for example, would be much more appropriate. The ER is one of the most expensive healthcare settings, and patients should only seek it out when necessary—and not for minor concerns. But patients continue to seek ER treatment in ever-increasing numbers. In fact, ER visits have risen steadily over the last few years. According to a survey of 2,098 ER physicians by the American College of Emergency Physicians, three-quarters of the doctors surveyed noted that visits rose steadily from January 2014 to March 2015. Additionally, one-quarter of doctors noted a “significant increases in all emergency patients” since 2014.

Educating patients on when and where they should seek treatment will help to streamline the overall healthcare process and lower overall ER visits.

Saving time

Primary care doctors are increasingly short on time. Since fee-for-service care is structured around the concept of treating as many patients as possible, doctors usually try to squeeze in a high volume of patients during their workday.

In fact, in 2014, general practitioners and family physicians reported seeing an average of roughly 90 patients each week. It’s typical for doctors to also schedule short, 15-minute appointments, but some physicians try to keep appointments to no longer than 11 minutes. These short appointments not only make it difficult for patients to communicate with their doctors, but doctors are becoming burned-out with the rapid-paced appointments: A 2012 study noted that 30 percent of doctors between the ages of 35 and 49 plan to retire within the next five years.

With value-based care, doctors will begin to treat fewer patients, focusing more so on achieving positive results as opposed to booking a steady stream of appointments. However, in order to help doctors free up their time and avoid burnout, healthcare providers should focus on increased patient education. Informed patients will ask fewer and more pointed questions, and they’ll have a better idea of what’s ailing them, which will help to keep appointments short.

Lastly, relapses and readmissions should decline, helping to free up doctors’ schedules.

Higher quality of life

Lastly, patient education delivers results, and after becoming educated about their conditions and required treatments, patients generally have a higher quality of life. For example, Gallup polled a group of patients who received medical device implantation.

For the patients who “knew what to expect after surgery” (i.e. they received effective patient education), 72 percent were satisfied with their results, and only 8 percent reported problems after the device implantation. For the patients who didn’t know what to expect, only 39 percent were satisfied with their results, and 27 percent reported issues.

Informing a patient—or, in other words, educating them properly regarding their treatments or illnesses—helps to improve their overall quality of life.

As the nation’s healthcare reorients towards value-based care, patient education will become especially critical. When used correctly by providers, patient education can be a valuable tool, helping to increase efficiency and boost quality of care. Educating patients doesn’t have to take a great deal of additional time or effort.

A thoughtful, patient-centered strategy coupled with the application of innovative technologies can make a significant impact. Patient education, thanks to the push towards value-based care, is taking its place as a strategic imperative for healthcare providers throughout the nation.

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Managing the surprisingly troublesome impact of real-time healthcare on clinical decision-making

We live in an age of instant gratification. From the texts we send friends and family to the orders we place on Amazon.com, we’ve come to expect immediate results: instant responses, next-day shipping, etc.

The idea of immediacy in healthcare communications is not new. In fact, in 2015, healthcare analyst Gartner outlined a vision for what it dubbed the “real-time health system”—a landscape where healthcare professionals will be constantly aware of what’s happening within their systems and with their patients.

As a person living in the digital age, you’ve probably experienced real-time awareness in other parts of your life: the repetitive dings of received text messages, the intermittent beeps of calendar alerts, the near-constant hum as your smartphone vibrates over and over to let you know your mother, children and cousins have uploaded photos to Facebook, Instagram and Snapchat. In fact, as I’m typing this piece, I’ve heard alerts for two personal text messages that I’ve yet to look at (the temptation is maddening), four work-related emails (that I did have to stop and look at), a notification that someone commented on a thread I replied to on Facebook and more.

While there’s definitely a benefit to each of us knowing what’s happening in our expanded universe in real time—and we can easily draw a direct line to the benefits that doctors, nurses and patients would experience if they could communicate instantaneously while coordinating care—the influx of information is simply overwhelming.

And when alarm fatigue sets in, important messages get missed, the communication cycle breaks down and what was once a valuable resource becomes a liability. Overwhelmed and inundated clinicians cannot optimally use their invaluable expertise to make effective clinical decisions that deliver great health outcomes.

Aggregating, analyzing and managing the distribution of clinical information

Managing the flow of data and alert fatigue is a real challenge that clinicians and the IT teams that support them need to understand. Clinicians need “just the facts, ma’am,” so to speak, and they need to know which set of facts pertain directly to them and the patients for whom they are caring. Receiving more than enough information is not always a good thing, especially when the situation calls for fast thinking and quick decisions.

Investments made in technologies implemented over the past several years have enabled healthcare as an industry to generate very large amounts of digitized clinical information. The challenge is to aggregate this patient data in real time to generate new knowledge about a patient and distribute it in a way that does not inundate the clinician recipients with unnecessary information. Physicians and nurses should receive information they need in order to act in that moment. Everything else is noise.


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Implementing communication-driven workflows

Once new knowledge is made available and deemed relevant to a given clinical situation, it’s important to enable workflows that drive this information to the right care team members, who can take action in that moment. Hospital-based communication workflows must encompass all modalities, adhere to strict security mandates and facilitate reliable exchanges among clinicians across boundaries (e.g., acute, pre-acute and post-acute care settings). This kind of clinical integration is the future of healthcare communications.

If clinicians are inundated with unnecessary information, messages and alerts, combined with a communication workflow that creates barriers to a) finding the right care team member to contact, b) finding the contact method that the clinician prefers and c) knowing whether the intended recipient received the message, the workflow is flawed and is inhibiting the decision-making that leads to higher standards of patient care.

Leveraging clinical expertise

The personal judgment of experienced healthcare professionals is irreplaceable in effective, real-time decision-making. Technological advances are no doubt improving healthcare, but human intuition can never be replaced by a new device or software. However, that intuition can be inhibited by technologies if they are not strategically implemented and managed. In this sense, real-time healthcare could, ironically, be eroding quality.

To truly leverage the hundreds of collective years of clinical expertise housed in the minds of your hospital’s medical staff—the expertise that yields great outcomes—you must remove the barriers to effective communication. Collecting patient data in real time is an important part of that. But analyzing and aggregating that data into digestible, valuable pieces of information that can be easily shared and collaborated on is the follow-through that is often overlooked.

The gravitation toward instant gratification isn’t going away. And it’s important to understand that the concept doesn’t apply simply to generating patient data as healthcare events are occurring, but also to the ability to extract the significant portions and begin collaborating with the broader care team to interpret the data and derive a plan to deliver high-value care.

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The role of secure communications in your clinical integration strategy

If you could take one solution with you on your journey to clinical integration, what would it be?

Clinical integration is the unification of healthcare data, services and coordination across acute, outpatient and post-acute care. It portrays an environment where waste and inefficiency are all but eliminated from healthcare communications, costs decrease and care improves. It’s the future of medicine.

You wouldn’t be far off course if your first thought was to rely heavily on the EHR to support your clinical integration strategy. While the EHR is a valuable tool for sharing patient information within hospital systems and broader care networks, it lacks a fundamental quality that bridges the gaps between Meaningful Use and true clinical integration.

Fully realized clinical integration can only occur when the barriers of communication have been broken down, and interdisciplinary clinicians can accurately and reliably coordinate care in real time across organizational and geographical boundaries. As with most things related to healthcare communication and the sharing of information across disparate networks, securing those communications has been and will continue to be a primary focus for healthcare IT leaders. In an environment where healthcare organizations are driving toward an end-goal of clinical integration, enabling secure communications alone just isn’t enough.

To achieve clinical integration, clinicians need a solution that enables immediate, accurate, reliable and secure communications.

Immediacy in healthcare communication

Real-time communication is a crucial element of delivering high-value care. In the most critical emergencies, every second counts. The time that clinicians waste identifying the right on-call care team member to contact, and then trying to reach that person, can quite literally be the difference between life and death. Even in non-emergent situations, early detection and treatment are well-known effective preventers of worsening conditions.

Yet it’s all too common for inefficient and broken communication workflows to create time-consuming hurdles for clinicians to clear—sometimes even to just begin the conversation.

Clinically integrated settings approach clinician-to-clinician communication with a sense of real-time urgency. That’s not to say that every message should be sent with an emergency status, just that the process of identifying the provider you need to connect to and the delivery of that message should be seamless and immediate.

Reaching the right care team member on the first attempt should be an important metric for all hospital systems. To keep performance numbers high in this area, you must ensure clinicians always know exactly whom to contact for any given medical issue.

However, most clinicians today initiate time-sensitive contact to the broader care team by thumbing through a lengthy paper-based on-call schedule, making a call, and then waiting to receive a response.

Real-time clinical communication and collaboration tools immediately deliver secure communications, and even allow the clinician initiating the communication to see in real time when messages are delivered and read.

Contact accuracy

Reaching providers on the first attempt is important, but it’s just as important to reach the right provider—the one who can act on the medical issue at that moment—via his or her preferred method of contact.

It’s not uncommon for providers to have a different preferred contact medium for every variance of their schedule. And it’s not uncommon for those schedules to change at a moment’s notice. Yet many hospitals, in both small and large systems, only print the schedule and patient assignment lists once per day.

Clinicians in this setting have no way of knowing if they are accurately reaching out to the right providers via the right contact method. Manually producing a list of whom to contact and how is a process riddled with opportunity for inefficiency and inaccuracy.

Dynamic Intelligent Routing™ eliminates those opportunities for communication breakdown. A distinct capability of PerfectServe, Dynamic Intelligent Routing analyzes workflows, call schedules and contact preferences, enabling clinicians to reach the right person at the right time with just the tap of a button.

Reliable communication workflows

If your clinicians depend on inaccurate call schedules or outdated, cumbersome processes to drive clinical communications, your communication workflow isn’t reliable.

When clinicians can immediately contact the care team member they need via that provider’s preferred contact method, communication workflows become reliable and trustworthy, which leads to high adoption and improved patient care, no matter the care setting.

From improved care coordination to reduced costs

Inefficient communication workflows not only interfere with the realization of clinical integration, but also they inflate healthcare costs. For example, if a radiologist identifies a critical result in an outpatient test, the radiologist needs to contact the patient’s PCP so action can be taken right away. If the communication is not immediate, accurate or reliable, the process breaks down and the delay could result in medical complications for the patient that end up costing more to treat.

Moving a patient safely through the admissions, treatment, discharge and post-acute care processes requires a tremendous amount of coordination, good communication and a sound clinical integration strategy. The tools you use to support that communication and collaboration will play an important role in your success.

The what and why of physician engagement

As Mark Dixon pointed out in The Changing Role of the Physician, the healthcare industry continues to undergo transformation that will improve outcomes of not just one patient, but that of the entire population. This transformation will require physicians to step up and lead their peers through these critical changes. Physicians influence every step of the care process. However, physicians’ background, outlook, and training are different from hospital leaders, creating challenges in how to respond rapidly to marketplace and regulatory change.

A seat at the table

Why is physician engagement so critical for a successful patient care experience in hospitals today? A physician from upstate New York said, “When we are not invited to sit at the table, we feel like we are on the menu.”

When physicians feel a lack of engagement, it manifests itself in ways ranging from burnout to leaving their jobs. Physician employment alone does not yield engagement. The same skills of communication and collaboration are needed regardless of the percentage of employed physicians (Perry MR. A Local Solution for Hospital-Physician Relationships. Frontiers of Health Services Management 24(1):31, 2007).

What is engagement?

There are two definitions of engagement. One meaning involves a promise, as in engaged to marry. The other involves conflict, as in engaging the enemy. Perhaps it’s this dual definition that makes healthcare organizations struggle to understand how to get physicians engaged. According to Tom Atchison in Leading Healthcare Cultures: How Human Capital Drives Financial Performance, physician engagement is an intangible process that depends on the degree to which doctors are proud, loyal, and committed to a hospital’s mission, vision, and values. It differs from alignment, which is a tangible, time-delimited state reflecting compensation and contractual mandates.

Easier to pronounce than to achieve

Physician engagement is challenging because physicians and hospital administrators have different backgrounds and outlooks on how to deliver care. Physicians are trained to think in hours or days, whereas administrators’ time horizon may extend for years. Physicians and administrators also may differ in their perception of teamwork. As Joe Bujak wrote in Inside the Physician Mind: Finding Common Ground with Doctors, physicians view themselves as members of an expert culture who conceive of teams in terms of individual performance, like members of a golf team who compete in their own matches. However, administrators tend to see themselves as part of an interdependent affiliated culture, like members of a volleyball team, who dig, set, and spike to win points.

 

Dr. Cohn is CEO of Healthcare Collaboration that works with disgruntled doctors and hospital leaders to improve clinical and financial performance. He has mentored physicians since 1998, finding that physicians enjoy learning from fellow physicians. His recent novel, Dead at His Desk, explores the conflicts between physicians and hospital administrators using the framework of a mystery thriller. His webinar, Physician Engagement: A Case-Based Approach, will take place Tuesday, February 10, 2015 at 1:00 PMEST.

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