Saturday, March 5, 2016
Gaining Patient Compliance
The patient compliance conundrum reads like this. If only patients would comply with regimens government and doctors recommend, patients’ health would improve, but patients have minds of their own and resist conformance.
To solve this puzzle, to achieve patient compliance, government relies upon through individual, employer, contraceptive mandates, and financial rewards for performance improvement. Doctors, employers, and other others seek to upgrade compliance through rewards for wellness, health monitoring, and long-term medications.
The only thing standing in the way of these goals is patient noncompliance and human nature, which treasures individual choice and freedom to do as one pleases.
The definition of compliance, says my dictionary, is: 1. the act of conforming, acquiescing, or yielding 2. Tendency to yield readily to others in a weak of submissive way; 3) conformity, in compliance with orders from others 4) cooperative or obedience.
Another definition to consider is “regimen,” which medically is thought of as a required course of diet, exercise, or manner of living intended to preserve or sustain health.
But patients tend to be non-submissive and non-permissive with non-regimens of their own.
How to achieve compliance and improvement of health in individualistic Americans with ingrained habits and an attitude of non-submissiveness and noncompliant behaviors in a free society poses problems.
Various approaches have been tried - Nutrisytems or Weight Watcher s regimens of replacement diets or group therapy sessions with predictable weight loss; use of long-term injectable medications that circumvent the problem of patients’ daily options of ignoring or following directions; technological tracking innovations to assure patients are complying with the regimen or responding positively to it; political rewards by employers in the form of financial incentives to stay well.
The March 3 NEJM contains two articles addressing the opportunities and problems of two of these approaches.
In the first article, “Effect of Removal of Planned Parenthood from the Texas Woman’s Health Program,” 5 authors from the Population Research Center in Austin conclude, “For women using inject able contraceptives, there was a reduction in the use of contraceptive continuations and an increase in the rate of childbirth covered by Medicaid.” Injectable long-term reversible contraceptives (LARCs) effectively remove the daily compliance problem.
The second article, with the misleading title of “Uber’s Message for Health Care, “ by 2 physicians at the University of Toronto, compares the effect of Uber, the IT-driven international transportation delivery system, the rider-driver matcher service, which has driven down costs in 150 U.S. cities and 58 countries to the limited usefulness of technology in changing the medical system and advancing the cause of patient health. The authors note that billion dollar backing of venture-capital companies has not significantly altered the physician-dominated delivery system.
As examples, they cite the experience of retail clinics , which despite rapid growth, still account for only 2% of primary care visits, and 6 companies backed by more than a billion dollars from venture capitalists - Theranos, ZocDoc, Intarcia Therapeutics, Oscar Health Insurance, Proteus Digital Health , and 23andMe, all designed to achieve patient control, efficiency or compliance.
With Intarcia Therapeutics, the idea is to give once or twice yearly IM injections of medications to avoid the problem of daily compliance; and with Proteus Digital Health, the concept is to embed sensors in ingestible pills, to track whether poor compliance contributes to treatment failure or poor outcomes.
The Toronto pundits say doctors have 3 choices: ignore venture-capital backed innovations, call for regulations to block innovators from entering market; or compete on quality and efficiency to win patient trust and compliance.
How can doctors get patients to comply,
To regimens on which their health does rely?
Do they prescribe long-acting medications.
Track vital sign and outcome fluctuations,
Ignore venture-capital backed innovations?
Or do they compete on quality and efficiency,
To gain patient cimpliance through proficiency?