Last week our behavioral and creative teams had the privilege of receiving a 1-day health coach training from experts at the UNC-Greensboro Department of Public Health Education. This training was a unique opportunity to learn best practices when working with patients in the most intimate of settings: a health coaching session.
The dynamic day included an explanation of the 3 different styles of communication used in coaching: Directing, Guiding, and Following.
“Directing” takes place when the coach tells the patient what to do and the best way to do it. “Following”, on the other hand, has the coach openly listening with no agenda, and following along with whatever the patient wants to discuss. The “Guiding” style is when the coach affirms that the patient is capable, and works to increase the patient’s ability to change the desired behavior, guiding them through questions and conclusions rather than dictating them.
It was interesting to learn from this training that, though guiding may be favored in our changing healthcare environment, there is a time and place for each of the 3 styles of communication in talking with patients. There are times when, for the patient to understand the gravity of a diagnosis or necessity of treatment, the doctor should use the directive communication style. The patient needs to know exactly what to do and how important it is to do it. Other times following may be most appropriate, if the patient simply needs time to have their thoughts or concerns heard.
A big part of my internship with MicroMass this summer is working on a research project that looks at the trends in doctor/patient communication and how the way in which a doctor communicates with the patient may bring about different patient outcomes. We’re currently fielding the study, and are eager to learn more about the doctor/patient relationship from people living with chronic disease. Of particular interest is learning how these different coaching styles are being used in real-world situations and how they may impact both positive and negative outcomes.
The question is –which style is most beneficial when? And how can the healthcare provider figure that out in at any given moment? We are looking forward to seeing how the results of this study bring us one step closer to finding out.(Read full post)
When people find out I do pharmaceutical marketing, they act like they’ve met a Yeti. “YOU do those ads on TV with all those nutty side effects?!” And then the questions begin.
“How come those ‘sick’ people look so happy?”
“If I get that disease will I have a lake house, too?”
“What’s with all the side effects?”
“What in the heck is a ‘fatal event’ anyways?”
And my personal favorite—“Why do they always say ‘talk to your doctor’? Don’t you HAVE to talk to them to get the prescription?”
I may not have deep answers to any of their other questions, but I can answer that last one. Yes, you do have to talk to your doctor to get started. But that talk needs to be more than you going into his office to announce your interest in this shiny new drug and expecting him to just whip out his prescription pad.
Sure, you want to talk about that awesome commercial you just saw. Sure, you want to know what a “fatal event” is and if those magic new prescription-only eye drops are worth the risk. Sure, you want to know if your insurance will cover this. But even if you get beyond all that, the conversation is not over.
Now you two have to talk about your role in your treatment plan with these little droplets. This is an essential and unfortunately overlooked step that can make a huge difference. This is the part where you find out if this is a treatment plan you can actually adhere to. Perhaps you have to inject the drug into your ear 6 times a day. And then lay flat for 2 hours after each injection. If you have a job where sitting upright for long periods of time is encouraged, this drug may not be for you. But if you have an honest talk about your treatment goals and your lifestyle, you can find out what will be best for you.(Read full post)
Patient engagement is a concept that we’ve been hearing a lot about for the last couple of years and one that is critical to impacting health outcomes. As we’ve seen in our own research, oftentimes industry terms are considered buzzwords and carry different meanings to different people. While there isn’t true consensus on the exact definition, even greater uncertainty for me remains around the steps required to actually create an engaged patient.
Type “patient engagement” in Google, and you get 754,000 results. There are sites that claim they’ll help you boost patient engagement, help you create motivated and engaged patients, and even provide tools to help healthcare providers better understand why patient engagement is so important. Clearly, it’s an important topic, but who do you listen to when it comes to motivating patients? What is truly important?
I watch a lot of TED Talks, and one that sticks out in my mind was presented by e-Patient Dave. Dave was diagnosed with terminal cancer, but through networking and social media, was able to find a treatment that ultimately saved his life. He has a website that contains his own postings, guest entries, and other resources from the patient and HCP perspective.
In March, Dave shared a guest post, written by Dr. Patricia Flatley Brennan, that talked about the importance of technology in creating an engaged patient. I agree, technology allows for so many different experiences for patients and providers that were not available just a handful of years ago. But when I read the title, Patients+Providers+Technology=Engagement, the first thing I thought was, “It’s not this simple.” Questions and thoughts were popping into my head, like:
- What if patients have inaccurate perceptions about their condition?
- What if the provider uses terms that the patient doesn’t understand?
- What if the technology is just information overload?
- Technology alone isn’t the answer
Dr. Brennan makes some really good points. For example, she talks about the fact that patients are truly the experts when it comes to their own bodies. She also talks about the importance of patient-provider communication. But she goes on to state “the key to…creating successful partnerships between patients and providers is technology.” As a behavioral science expert, this made me nervous. We don’t want to be sending the message that if technology is included, patients will be more engaged. As I stated earlier, it’s just not this simple.
Take physical activity trackers, for example. Lots of people use them to track their daily activity. They may even bring their trackers to doctor’s appointments. But these trackers are nothing more than a digital way to track activity. For patients who are also struggling with things like not knowing how to exercise, not knowing what exercises to do, not knowing what equipment they need, or believing they need to lose 50 pounds for it to matter, a tracker, while digital, isn’t going to help them with these underlying issues. As a result, they are no more engaged before or after using the tracker.
I don’t dispute the value of any of the programs that are presented in the posting. In fact, many of them look really great, and deserve attention for the positive change they’ve helped create. What I am cautioning against more generally is promoting technology alone as the key ingredient. While technology is important, paying attention to the underlying drivers of behavior is equally critical in promoting change. Starting with an understanding of what drives behavior, then integrating this with technology, can yield powerful tools that will not only change patient behavior but also impact health care delivery and clinical outcomes.
I’m not in any way downplaying the role of technology here, but suggesting that taking into account the drivers of behavior can lead to even more meaningful technological developments.(Read full post)
It happens to people all over the world. A man loses his job and has no idea how he is going to pay his monthly bills. And on top of it, he has a daily medication he needs to keep up with. He goes to the doctor, but because of a myriad of factors, he doesn’t disclose the fact that he just lost his job. He’s tired. He’s embarrassed. He’s in denial.
What the doctor doesn’t know is that Tom is about to spiral into a bout of serious depression. He will become disengaged from his own care simply because he will be in “survival mode” over the next few months. Tom will stop taking his medication every day, and since the doctor won’t see Tom for another 6 months, it’s not until then that the doctor realizes that Tom’s health has declined greatly due to non-adherence.
At the other side of the country, Carla is diagnosed with HIV. Her doctor prescribes Complera, which is a drug that requires patients to consume at least 400 calories with the drug. Overwhelmed and reeling, Carla doesn’t ask questions. The problem? Carla is homeless and doesn’t consume 400 calories at any given meal. Carla takes the medication and because she does so on an empty stomach, she experiences very difficult side-effects and decides not to adhere to her medication. She sets off down a path of resistance to an entire class of HIV medications.
Where is the disconnect? Providers often do a great job developing rapport, and many patients trust and value their physicians. However, as evidenced by non-adherence trends, something isn’t clicking in those exam rooms. If Tom’s doctor had said “So, what’s going on in your life these days, Tom? Has anything happened recently that might get in the way of you taking your meds?” or if Carla’s nurse said “Walk me through a day in your life” or “What is important to you when you think about taking an HIV medication” then maybe they would have realized that Carla needed a different medication because of her circumstances.
A recent study in JAMA showed that there are difficulties teaching effective communication to providers. In the study, 472 internal medicine and nurse practitioner trainees were randomly assigned to either participate in an eight-session, simulation-based communication course, or to forgo communications training. The end results from patients indicated that there was no difference in satisfaction with the ones who had been trained. In fact, the patients who talked with providers who had the training were more likely to be depressed.
What if we focused on engaging patients instead of only thinking about the communication aspect? Providers don’t need to be trained as expert communicators, but they do need to delve deeper into the life of a patient in order to uncover key information that the patient isn’t telling them. By doing this, providers will be able to tailor the treatment regimen in a way that will ensure optimal adherence/buy-in from the patient.(Read full post)
According to a report just released by the Center for Health Law and Policy Innovation of Harvard Law School, people with type 2 diabetes could lose up to 15 years of life because of the disease, and by 2025, diabetes could cost the state over $17 billion a year in medical expenses and lost productivity if the epidemic continues on its current path. Changing this is not simple, but there are many initiatives underway focused on making sure this does not become a reality.
This was the topic of the PATHS (Providing Access to Healthy Solutions) conference I attended on May 30. The good news is that there are many people who care about this issue and want to do something about it. The hard part, at times, is knowing where to start and how to actually make a difference.
While at the conference, I had the pleasure of sharing our work on women and diabetes along with Brandy Barnes of DiabetesSisters, as you see in the image below. I’ve been collaborating with Brandy for the last 5 years, and she has been able to take insights from our study to help inform the programs she offers through her organization.
I also had the opportunity to share some information about MicroMass’s Time2Focus diabetes app with some other conference attendees. As I wrote on April 22, 2014 in a previous blog post, this app is designed to help build patient confidence and problem solving skills so patients can make educated and empowered decisions on a day-to-day basis related to their diabetes. Recruitment for our clinical trial is underway, and we are eager to begin helping patients, one-by-one, make changes in their lives so they can live healthier, more productive lives.(Read full post)
“Patient engagement is the blockbuster drug of the century.”
“Patients are the most underutilized resource in healthcare.”
“Patient engagement is the name of the game in health care delivery.”
Those of us who subscribe to industry newsletters have seen an undeniable shift in the conversation about health care delivery. More and more, patient engagement and patient centricity have been touted as the new standard. Working at MicroMass, this feels a little like a “duh”, since we have been developing patient engagement initiatives for our clients for years. But patient engagement is now not just for the innovative and the bold.
The health and life sciences field has been thrust into sparsely-charted territory. And the stakes are rising, especially for physicians whose pay under the Affordable Care Act will depend on their ability to engage patients in their care. (Patient engagement has been shown to impact patient satisfaction ratings and health outcomes, to name a few key evaluation metrics prescribed by the ACA.) Luckily, this intimidating new landscape can be navigated with the help of a variety of tools and innovations.
One way in which providers can engage their patients is by utilizing shared decision-making processes. Shared decision-making involves patients and providers exchanging medical evidence and personal preferences and values to come to a decision about a course of care. What sounds like a simple concept is actually quite difficult to accomplish in the context of the American health care system (think rushed appointments, disjointed processes of care, and a general lack of experience and skills among providers to use evidence-based communication techniques that facilitate patient collaboration).
To enable a shift toward shared decision-making in the context of a health care delivery system, the nonprofit research organization RAND Corporation has published findings from their study on establishing shared decision-making processes. One of the key aspects they identified was the use of decision aids. High quality decision aids provide objective and patient-friendly information on testing and treatment options for patients to consider, as well as prompts to encourage patients to reflect on their own preferences and values.
Decision aids can be disseminated to patients in the comfort of their internet browser, in the waiting room, or in the provider’s office. These resources have proven to be a useful step toward patient-centered care. When it comes to patient engagement, sharing really is (health) caring.(Read full post)
The Affordable Care Act has plunged electronic health records (EHR) into the process of care. And ultimately there are many advantages that I think we will see – greater continuity of care, and the ability to measure and track meaningful population level health outcomes. Along the way, health systems and ACOs have to demonstrate “meaningful use” of EHR – meaning that health professionals must demonstrate that EHR is being used to have a positive impact on patient outcomes. This push for meaningful use has led to a number of applications including patient health portals. In the context of patient health portals, providers are demonstrating meaningful use of electronic health records by allowing patients to have access to their medical records and health information online. Sounds great, doesn’t it? Give patients more information, because more information is what they need. Right? Not necessarily. In fact, a recent research letter published in JAMA demonstrates that meaningful use of EHR yields marginal and in some cases, worse, quality care measures.
On the surface, patient portals have benefits. It’s convenient. You can review test results online. Some health portals even allow you to exchange messages with providers – but not many are welcoming this functionality yet.
For two reasons, I would argue that this attempt to cast patient portals as a meaningful use of EHR is a little misguided, maybe even meaningless – if you think about it in the context of advancing patient outcomes.
First, without context from the provider, test results and other medical information is open for interpretation. Let me speak from firsthand experience. I recently reviewed some lab results for my mother via her provider’s health portal. It was easy to access. There were a ton of test results and the ranges for normal and abnormal were listed alongside her results. Even as a nurse, I honestly had trouble interpreting what the results meant. Given the context of her symptoms, of previous lab results – without guidance from her provider, I found myself feeling unnecessarily alarmed by what I was reading. Even with additional research online to help me interpret the results, I still felt confused. So, we waited for her appointment 3 weeks later and the provider guided us through the results, helping us understand why he had ordered those specific lab tests, what they meant, and what the next steps were. Information without context cannot be absorbed in meaningful way.
Secondly, while information is great, information in itself does not engage patients in care. Decades of behavioral science research demonstrates that knowledge does not equal behavior change. Patients need motivation and also just as important, the skills to effectively engage in their care. Some suggest that patients having access to their medical records is the “single most powerful moment in the movement towards the empowered patient.” I disagree. While I think access to medical information and medical records is certainly a small step towards engaging patients, there’s much more on the table to think about. Patients can’t become actively engaged in their care unless “we meet patients where they are” and equip them with the skills to self-manage their condition.
No doubt, technology can play a powerful role in patient health in many ways. However, in terms of patient portals, I look forward to next generation applications of EHR that not only fully harness the technology and data, but also leverage a fundamental understanding of patient behavior and what it takes to equip patients to engage in their care.(Read full post)
Publications, slide presentations, posters — for those involved in the development of medical communications strategies, these channels are most frequently leveraged to communicate with your primary audiences. But are they successful in terms of actually changing the behavior of your primary audiences? Isn’t it possible that we become so focused on the number of publications we publish each year that we lose sight of the primary end goal — a better patient outcome?
In a rapidly changing healthcare environment where the patient has an increasing role in determining his or her outcome, should those involved in planning and managing medical communications plans challenge the traditional definition of medical communications to incorporate the role of the patient?
I challenge those responsible for developing strategic medical communications plans to ask themselves 4 key questions:
- Is this strategy helping to pave the way for meeting our organization’s objective of achieving improved patient outcomes?
- Are my medical communications efforts actually changing the behavior of healthcare professionals?
- Are there more effective ways to disseminate data that would facilitate active participation from healthcare professionals and patients?
- Could my medical communications plan be doing more to prepare my product for success in the real world?
If you answered ‘yes’ to any of these questions or are interested in learning more about our philosophy of building communication and dissemination strategies, please visit our website at medcom.micromass.com(Read full post)
Wearables have exploded in popularity over the last three years, particularly in the physical activity space. The market is flooded, there’s a new product announced every other month it seems. There are offerings from a large variety of manufacturers ranging from crowd-funded startups (Misfit’s Shine) to long-established players in the hardware tech space (Jawbone’s UP series).
However, the hard reality is that on their own, wearables struggle to drive long term adoption and lasting behavior change. The prevailing trend is that utilization is initially high but eventually tapers off.
But why do people abandon their devices? This question is of particular interest to the healthcare community since the prospect of gathering more patient data means that treatment, whether medicinal or behavioral can be more effectively tailored to the needs of the individual. The long-term adoption challenge has created a degree of skepticism around the true utility of personal activity trackers. For healthcare, relying on a data source often means considerable investment from one of several possible payers in order to ensure that patients have access to the technology and are well-educated in its use.
Contributing Factors to Device Disengagement
Lack of Motivation – The ability to track activity easily and effectively can be a powerful tool in the hands of a person that already has the motivation to get physically active. However, the ability to track isn’t a substitute for the intrinsic motivation to engage in the desired behavior(s).
Lack of Context – This is directly related to the motivation issue outlined above. For some users, the novelty of a new tracker and the feedback it provides does yield the temporary motivation to increase their levels of activity. The notion of context is critical to making feedback valuable. Giving a user knowledge that he walked 3,500 steps in a day is largely useless without also providing the insight that he should be closer to 10,000 steps in a day. Even then, if the user doesn’t understand the significance of the 10,000 step target in the context of maintaining health, the goal could be perceived as arbitrary.
Solutions that fail to help users connect short-term behaviors to long-term progress are subject to abandonment because from the user’s perspective, engaging in positive behaviors isn’t connected to progression towards a larger, more meaningful goal.
Lack of Actionable Insight – Personal activity trackers are invariably accompanied by dashboards that show users their performance across a variety of metrics ranging from step count to heart rate. Metrics are visualized using an assortment of graphs in order to allow users to see their progress over time. Presumably, the larger purpose here is to provide users with a high level of granular data with the expectation that they will examine the data, recognize trends and modify their behavior accordingly. This approach is problematic because it hinges on the assumption that the average user has a high comfort level in extracting insights from raw data in the absence of guidance. Needless to say, this just isn’t the case. A chart isn’t actionable for most people, but what is actionable is a distilled insight that allows them to see the connection between two interrelated metrics. Generally, the connection should? be apparent in the absence of granular data. “On nights where you sleep more than 6.5 hours, you average 500 additional steps the following day”.
Integrating Devices into Patient Care Scenarios
How can patients and healthcare solution-builders benefit from the transparency derived from wearables while also driving lasting engagement?
First, wearables should be utilized as a single part of a broader behavioral intervention. Behavior is a large determinant of patient outcomes, particularly in chronic disease. Giving patients a physical activity tracker and expecting them to magically get active is no more effective than giving patients a glucose meter and expecting them to immediately stop the behaviors that contribute to volatility in their blood sugar. An effective behavioral intervention delivers knowledge, skills and tools.
Secondly, wearable technology should be integrated into the broader intervention in a way that helps solve the aforementioned motivation challenge. Motivation is a complex topic that warrants many independent posts. But, the short of it is that many patients want a positive health outcome, but they’re encumbered by behavioral barriers that hinder their ability to engage the requisite behaviors. Wearables present an opportunity to gain granular insight into patient behavior, correct what isn’t working and encourage more of what‘s working well.
Lastly, the data that’s collected should be analyzed for the purpose of being made actionable. Delivering algorithmic analysis and insight against collected day may not be feasible for many organizations in the first iteration of a solution. Human analysis is an entirely acceptable means to pulling insights from data. This analysis can come from a person that’s associated with the intervention team, or it could also come from a patient that’s been educated in which connections are meaningful and the types of trends to look for.
Wearables have incredible potential to aid stakeholders on both sides of the equation by providing a level of behavioral transparency that was unfathomable just a few years prior. But, to realize the potential of the medium, patients and solution-builders alike must understand that the wearables are but a single tool in what should be a comprehensive wellness solution.(Read full post)
Mother’s Day is by far my grandmother’s favorite holiday. I asked her one day what made the day so special, why this day over the merriness of Christmas or the happiness of celebrating her birthday over the last 85 years. This question was met with a chuckle and after a slight pause she responded, “…because it’s the one day that whatever I say goes. People always telling me the things I should be doing, you know take this pill, eat this, do that, but they listen to me on that day and I love it.” She patted me on my lap and scurried back to tending to her business but it left me thinking. I started to really ponder, not just about how it must feel to not be in control of personal matters but what about her healthcare.
My aunts and mom take turn tending to my grandmother’s every health need, from providing transportation to doctor appointments to having thorough conversations with the provider about her treatment plan. Whatever the case may be, my grandmother always has the support she needs when it comes to matters of the health. But let’s think about this for a moment. Is there a difference between family engagement and patient engagement? Can a patient support system’s knowledge, skill and confidence for managing the patient’s health overshadow the need for patient engagement?
There is tremendous research that highlights the positive impact of patient engagement. In fact, patients who are more actively involved in their healthcare experiences better health outcomes and incur lower costs. In order for this to happen one major component of patient engagement must occur, believing the patient role is important. My grandmother and other grandmothers like her should be able to have open and honest discussion with their families and health care providers about their health and what’s important to them.
Mother’s Day has passed; let’s be reminded that our mothers and grandmothers should have their say in the matters of their health. Not just yesterday, but every day. Patient engagement should always be about the patient.(Read full post)