Should Doctors Be Penalized for Patient Outcomes?

Leigh Page

Disclosures

November 03, 2016

In This Article

Steps to Improve Adherence

Experts agree that getting patients to follow through on medical and health regimes is the best way to improve outcomes. Four experts who approach adherence from different directions—a patient advocate, a hospital leader, an academic physician, and a private practice physician—have recommended some key approaches to help improve outcomes. These may work for you:

Provide patients with reminders. These range from phone calls to email reminders to digital reminders on pill box lids. But Wilkins says reminders address only forgetful patients, who account for 25% of nonadherence. Even a friendly call from an assistant may not affect an intentionally nonadherent patient, he says.

Simplify dosing. Reducing the number of times patients must take a drug—and, if possible, the total number of medications they must take—has been shown to improve adherence. A Cochrane review[2] found that this approach increased adherence by 8% to 19.6% (depending on the study).

Get patients involved in decision-making. Many nonadherent patients decide not to take their drugs owing to perceived side effects, and then they don't tell you about it. One way to tackle this problem is to help patients get more involved in choosing the therapy and understanding the side effects through handouts, videos, and other material used as decision aids.

A program at Massachusetts General Hospital in Boston uses this approach. "Previsit use of decision aids promotes richer discussions and allows for more efficient use of the appointment time," says Leigh Simmons, MD, medical director of the program. In a survey, clinicians at the hospital said they thought this approach improved quality of care, she says.

Help patients accept high medication costs. Patients often don't want to pay for a drug because they think it's less important to their lives than other activities they pay for. Dr Simmons says that decision aids and discussions with patients can help patients understand why the drug is important.

Improve the patient interaction. Some doctors can improve outcomes by changing the way in which they interact with patients, says Anthony Jerant, MD, family physician at UC Davis. Dr Jerant has developed SEE IT (Self-Efficacy Enhancing Interviewing Techniques), an interviewing method that is meant to boost patients' confidence in managing chronic disease symptoms. "The goal is to empower and motivate patients," he says.

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