September 8th, 2011 by StevenWilkinsMPH in Medical Art, Opinion
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Often the simplest solutions to problems are the best. So it would seem when it comes to the impact that increasing patient trust in physicians could have on many of the intractable challenges that face the health care industry everyday like non-adherence, lack of involvement, poor health status, dissatisfaction and so on.
I explore the link between patient trust and outcomes in the following infographic I curated and designed. What surprised me is how a patient’s level of trust in their doctor, like so much of what I talk about in this blog, boils downs to the patient’s perception of the physician’s ability to communicate: Read more »
*This blog post was originally published at Mind The Gap*
July 17th, 2011 by Jessie Gruman, Ph.D. in Opinion
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Twenty percent of people who leave their doctors’ offices with a new prescription don’t fill it. Up to one-half of those who do fill their prescriptions don’t take the drugs as recommended. These individuals are considered non-compliant. But does that mean they are not engaged in their health care? Engagement and compliance are not synonyms.
I am compliant if I do what my doctor tells me to do.
I am engaged, on the other hand, when I actively participate in the process of solving my health problems. This new prescription is an element in that process. If I am engaged in my care, I might want to learn about this medication. Such as: what it can and cannot do to ease my pain or slow the progress of my disease; what side effects it might produce and what I should do about them; how long it will take to work; when I should take it and how; how much it may cost; and what will happen if I don’t take it. I might want to consider the barriers to taking it and weigh the risks and benefits of alternatives. Could I instead make changes in my physical activity level or diet, try a dietary supplement or watchfully wait to see if the symptoms subside?
If my clinician has done more than just hand me the prescription – if she has, for example, raised these questions and discussed these concerns with me, I probably won’t have a prescription in my hand if I don’t intend to fill it.
But I can be engaged in my health care even if I don’t have that conversation with my provider. I can Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
June 18th, 2011 by Jessie Gruman, Ph.D. in Health Policy, Opinion
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I sat in a dingy pharmacy near the Seattle airport over the holidays, waiting for an emergency prescription. For over two hours I watched a slow-moving line of people sign a book, pay and receive their prescription(s). The cashier told each customer picking up more than one prescription or a child’s prescription to wait on the side. In minutes, the harried white-haired pharmacist came over to ask the person if they were familiar with these medications, described how to take them, identified the side effects to look out for and demonstrated the size of a teaspoon for pediatric medications. Then he asked the person to repeat back – often in broken, heavily accented English – what he or she had heard and patiently went over the parts they didn’t understand.
I was impressed. This is what every pharmacy should be like – except, of course, for the dinginess, the creeping line and the fact that it was so crowded I could overhear these conversations. Maybe if we got federal legislation enacted requiring pharmacists to offer counseling with each prescription filled, this kind of attention would be the norm, adherence to medication regimens would improve and drug-related injuries would be reduced.
Wait a minute. Someone already had that good idea. It was Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
May 25th, 2011 by Jessie Gruman, Ph.D. in Health Policy, Health Tips
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You are sick with something-or-other and your doctor writes you a prescription for a medication. She briefly tells you what it’s for and how to take it. You go to the pharmacy, pick up the medication, go home and follow the instructions, right? I mean, how hard could it be?
Pretty hard, it appears. Between 20 percent to 80 percent of us – differing by disease and drug – don’t seem to be able to do it.
There are, of course, many reasons we aren’t. Drugs are sometimes too pricey, so we don’t fill the prescription. Or we buy them and then apply our ingenuity to making them last longer by splitting pills and otherwise experimenting with the dosage.
Some drugs have to be taken at specific times or under specific conditions, posing little challenge when you are taking only one. But it can be devilishly difficult to coordinate the green pill half an hour before breakfast, the yellow ones on an empty stomach four times a day and the orange one with a snack between meals. It’s complicated; we don’t understand. We’re busy; we forget. We’re sick; it’s confusing.
Some drugs produce uncomfortable side effects while others set off an allergic reaction. Every single day, we have to decide if the promised outcomes are worth the discomfort.
Kate Lorig, the developer of the Chronic Disease Self-Management Program, has listened to thousands of people talk about the challenges they face in taking their medications as prescribed. “One of the reasons that folks do not take their meds is that they think they are not doing anything,” Lorig says. “This is especially true of medications that replace something that you no longer produce like thyroxin or medications for chronic conditions that help you get worse more slowly. The trajectory of a disease is not something one can usually sense, and people start feeling that their drugs are not making them better. Another problem is that people expect drugs to work at once like aspirin and antibiotics. Many drugs take days, weeks or even months for people to feel better. They lose patience.” Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
