Medical innovations surround us: needle-free vaccines, personalized medicine, bionic eyes. When most people think of innovation, technological or pharmaceutical advances come to mind. But what if there were one simple aspect of medical treatment that everyone had access to, costs very little, and could profoundly change the health of every patient with a chronic health condition? Would you consider that an innovation?
The answer is simple – communication between patients and providers. Words. Tone. Advice. Instructions. Questions. Communication is more of a fundamental than an innovation. But without communication, patients would not able to receive the care that is best for them. And providers would not know the important context in which to interpret clinical values and symptoms. In fact, without communication, doctors would not know about some symptoms at all—symptoms with no objective value or name—things like “I have trouble walking to my mailbox because I am so short of breath” or “My pain gets worse when I walk upstairs.”
Trust me, I am a fan of innovation. I just wonder if the fundamentals of health care are minimized because they lack the cool factor. And focusing on the fundamentals, like effective communication, can have a tremendous impact on both quality of care and healthcare costs.
Common chronic diseases in our population today, such as type 2 diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure, and asthma, all depend on patients self-managing and making everyday decisions, including interpreting and following medical advice, taking medication, following a diet, and deciding what information to share with their doctor. Patients largely manage their conditions on their own every day; providers get only a glimpse of what is going on. That’s why communications is so important.
What can be discussed in the average 7-minute patient-provider conversation to set patients down the right path? How should that 7 minutes be spent? What questions should the provider ask? What information should the patient share?
With many chronic diseases, prescription treatment is necessary. Indeed, patients must leave the office visit with the right medication for their needs. But I would argue that communication, not medicine, should be elevated to first-line therapy.
Providers have an opportunity to uncover what matters most to patients—and to uncover what patients are most willing to do. Discussing the clinical benefits of starting a new treatment does little to help patients who don’t see their condition as chronic. Perhaps that 7 minutes would be better spent on improving the patient’s health in another way, such as discussing goals related to diet or addressing challenges the patient is having with their medicine.
Healthcare organizations today focus mostly on clinical and technological innovations to improve both the continuity and the quality of care. Fundamentals, like communication skills, are getting lost in the mix. It’s time we think about equipping providers with the knowledge from recent advances in behavioral science by investing in skill-building programs and resources to help providers apply communication strategies such as motivational interviewing and shared decision making. These evidence-based approaches can drive the lasting changes in behavior and outcomes that are needed to meet today’s success metrics.(Read full post)
It is very hard to comprehend the depths of the tragedy that happened with the downing of Malaysia Airlines Flight 17 last Thursday. The implications of the 298 lost souls will continue to resound for decades to come.
Some of the lives lost were devoted to improving access, advocating for rights, creating innovative solutions, and sharing passion and commitment to end HIV/AIDS all over the world. Many of those individuals were on their way to the International AIDS conference in Melbourne, Australia. Dr. Joep Lange was one of the key researchers behind several HIV treatment trials and devoted his life to the development of affordable HIV treatments for use in resource-poor countries, in addition to preventing mother-to-child transmission of HIV. His death is an enormous loss to global health research.
We at MicroMass continue to turn our thoughts and prayers to the victims and families of this senseless tragedy, and salute the work that was done by the talented and visionary individuals on board Flight MH17 in the space of HIV/AIDS worldwide. May we honor Dr. Lange and those lost by continuing to contribute to their determined effort to end the spread of HIV/AIDS.
“If we can get cold Coca-Cola and beer to every remote corner of Africa, it should not be impossible to do the same with drugs.” –Dr. Joep Lange.(Read full post)
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)