Too often, patients with chronic conditions can feel like a burden on their clinicians or caregivers.
Chronic illnesses don’t take days off – they’re called “chronic” for a reason. Since most patients (and clinicians, for that matter) cannot spend all day, every day, in an exam room, much of the day-to-day disease management falls on the patient himself. same. This heavy responsibility can take a heavy toll on a person’s mental health.
The challenges of disease self-management
To put the challenges of self-management into perspective, this section will focus on a chronic disease that affects 422 million people worldwide and causes 1.5 million deaths per year: diabetes.
Outside of the clinician’s office, diabetes management is the patient’s 24-hour responsibility. Patients have to watch what they eat, monitor their blood sugar, take their medications, maintain a moderate exercise routine, and some have to self-administer insulin injections several times a day. They also need to know what to do in the event of a health emergency, such as a sudden rise or fall in blood sugar, which can lead to dizziness, loss of consciousness, vomiting, and other symptoms ranging from disruptive to life-threatening. And the more complex their diabetes, the more difficult patient compliance becomes.
If they manage their condition well, people with diabetes can lead relatively normal lives. However, everyone has their own unique set of circumstances influenced by their underlying physical health, personal background, geographic location, economic stability – the list goes on. That said, a few issues emerge as consistent barriers to effective diabetes management:
Lack of education and understanding of the condition
In order to truly understand how to self-manage, patients with complex diabetes and their families or caregivers need educational support about the effects of the disease on the body and how medications, exercise, and adjustments lifestyle can counteract these effects. And since most people depend on general practitioners for their primary health care, they may lack crucial, disease-specific education.
Intrinsic Barriers to Adherence
A patient’s socioeconomic status, age, cultural beliefs, and other health factors can inform how they view self-management advice or make it more difficult to access help. Underlying psychological factors, including anxiety, depression, and eating disorders, can also compound these problems or act as additional barriers to adherence.
Frustration with the complexity of treatment
When patients think their treatment is difficult or complicated, they are less likely to adhere to their self-management as recommended. Clinicians should ensure that patients do not experience adverse effects, both physical and mental, from the use of medications or home treatments. It is also important for clinicians to understand if patients are experiencing any unpleasant sensations associated with medications, such as fear of injections or difficulty swallowing pills.
In countries without universal health care, studies have shown that out-of-pocket costs are an important determinant of the likelihood that patients will adhere to their treatment. Patients who have lower incomes are more likely to face economic barriers to consistently taking their prescribed medications. Patients cannot be expected to overcome their own economic barriers, and many GPs are ill-equipped to help patients access more affordable treatments.
If left unaddressed, these barriers to successful adherence can lead to deterioration in the patient’s condition, reduced quality of life, development of additional health problems, long-term or repeated hospitalizations, or the death.
Despite these multi-faceted challenges, clinicians and patients can take steps to improve patients’ access to, and experience of, disease management.
How to improve patient care delivery systems
When patients understand and feel involved in their own care plans, they are much more likely to adhere to clinical recommendations.
The patient’s relationship with their health care provider is one of the most important interactions in health care, but it is only part of a larger support system. Augmenting the patient’s care team with a variety of support specialists—such as health coaches, counselors, care coordinators, and disease educators—can help patients adhere to treatment regimens and achieve better health outcomes.
These patient support methods can greatly improve self-management between office visits and make appointments more efficient and productive.
- Use additional support programs
- Approach communication from a patient-centered perspective
- Provide multiple communication touchpoints
How to help patients overcome barriers to adherence
Although it may seem counterintuitive to a clinician, the key to overcoming patient non-adherence is this: healthcare professionals must position the patient as the primary decision maker in their own care and actively support the patient’s efforts to achieve their goals of care.
Clinicians can embody this approach by asking the patient questions such as:
“What would you like to get from today’s visit?” »
“What is most important to you? »
“How can I help you achieve your goals?” »
“What is difficult for you? »
“What troubles you, worries you or frightens you? »
“Do you need help identifying less complicated treatment options?”
“Do you need help finding less expensive treatment options?”
Incorporating activities such as goal setting and problem solving into routine appointments will help facilitate communication between patient and clinician that goes beyond simple status updates. Plus, connecting patients with health coaches gives them the ability to easily ask questions and share self-management updates between appointments.
Alicia Warnock, MD, is the cchief operating officer Stability Health, a diabetes management company.