What's the saying about hindsight always being 20/20? With so much attention on discovering effective treatments and developing a vaccine, one of the most devastating effects of Covid-19 is being overlooked. Few are talking about its impact on patient adherence.
Matt Dickson, Vice President of Product, Strategy, and GM of Communication Solutions at Stericycle, points out that while we don’t yet have the benefit of hindsight in our current health crisis, we can draw lessons from the last global pandemic, the SARS outbreak in Taiwan in the early 2000s. During the SARS outbreak, a second wave of fatalities occurred when patients deferred treatment for long-term chronic conditions such as diabetes, which escalated into acute situations.
Dickson says, “We’re beginning to see some of that with the most recent pandemic. We’re hearing stories of people who have had strokes, heart attacks, and issues managing their chronic conditions avoiding the ER and failing to seek appropriate care. This is a pending disaster.” In fact, according to data published earlier this year in Morbidity and Mortality Weekly Report, 42 percent fewer people visited emergency departments across the United States in April 2020 compared to April 2019.
It's generally accepted that "once patients are diagnosed and put on a treatment regimen, 50 to 60 percent are likely to skip medications, follow-up appointments, and other treatment protocols. The personal and economic costs of inadequate patient adherence are enormous."1 But given the added stresses of a pandemic, the percentage of patients failing to adhere to care, treatment, and medication plans grows even more.
So what's the remedy? Health systems need to guard against a one-size fits all approach of blasting communication. Instead, they must take an enterprise view to conduct the necessary data analysis to risk stratify their population—collectively, across providers and at the health systems level—to send pointed communications to those who are at risk for chronic and high-risk conditions.
Understandably, Dickson cautions that a smaller provider or health practice may find targeting communications at this level a heavy lift. Although providers don't know you are avoiding the emergency room due to heart attack, they do know patients' past symptoms and can partner with their health systems to send messaging about how care patterns should not be interrupted.
According to a report on patient adherence from McKinsey:
"The healthcare industry is primed to look not only at whether patients adhere to treatment regimens but also at their behavioral patterns, demographics, and lifestyle choices. Conducting data analysis can help uncover opportunities to reshape behavior and craft specific interventions tailored to individual profiles. Health systems and providers have access to large volumes of data that can help predict behavior and enable tailored interventions if assembled and analyzed properly.
For example, analyzing claims and consumption data can highlight a patient segment that tends to skip dosages during the first month of treatment and abandon therapy completely within six months. New direct-to-patient channels, such as patient hubs and social media, can be used to reach such patients directly with planned interventions that could improve adherence."
Building on this concept, Dickson recommends the following actions to improve patient adherence during a pandemic:
- Tailor communications based on patient risk scores.
Send a positive message to lay the foundation and express care, "Hey, here's why you need to come in." At the same time, and in a very pointed way point out the things that providers and health system are doing to keep patients safe (e.g., telehealth, virtual waiting room, separate entrances, masks, etc.).
Additionally, consider all demographic information when tailoring communications. For example, does changing content impact no-show rates? Low overall literacy may impact health literacy and may require simpler and more positive words to positively impact adherence.
- Organizations that triage can make the best uses of what they have—even incorporate mental health as a component of the adherence strategy. Dickson also cautions that mental health contributes to non-adherence during a pandemic. "People are isolated. They have little or no access to support systems. Fearful of losing their jobs. Fearful of getting COVID," he said. "They stop adhering and they get sicker and sicker, which then affects their mental health. It's a dangerous downward spiral and the number one reason patients miss appointments right now."
- Conduct targeted analysis for key areas such as post-discharge to help inform strategies. Ask questions about what that population looks like after treatment. What is my incidence of people in the ER with a stroke? Are they adhering to a treatment plan? What is the financial impact?
- Run a/b tests to begin to detect behavior. As the organization collects more data, determine which set of methodologies (cadence, method, etc.) get people to take action. Dickson suggests that systems use very specific messaging based on more data points. The more personalized the better. An 82-year-old patient with cognitive or emotional challenges is going to need a very different patient engagement strategy than a 30-year-old patient.
According to Dickson, "Messaging that doesn't lead to action makes your budget meaningless. The idea is that you have to be smarter with your spend."
To hear more about how healthcare organizations can raise adherence levels and contribute to better patient outcomes—even in the middle of a pandemic watch our free on-demand webinar: Patient Adherence-The Hidden Costs of COVID-19.