The purpose of medical collaboration is to improve care.
Yes, it decreases costs. Yes, it has a highly positive ROI. Yes, it can cut provider burnout.
But ultimately, the true purpose is to care more effectively for our patients.
But whatever the care plan we devise — together — it doesn’t do anyone any good unless our patients comply with the treatment. Pills left unswallowed, visits left unmade, and wound care left undone won’t help our patients.
So I was really interested to read two recent studies looking at the issue of noncompliance.
The first, in JAMA, looks at a study that used behavioral strategies to improve the percentage of patients who took their post heart attack medicine. The researchers assigned 1500 people who had recently had a heart attack to two groups. One group received the usual care. The other got a pull-out-all-the-stops treatment to make sure they took their medication: electronic pill bottle with reminders from family and friends; cash rewards for taking the medication; help from assigned staff, etc.
The results were sobering, really. The group with the pull-out-all-the-stops treatment were hospitalized at the same rate as the other group, they incurred the same costs — and they even took their pills at exactly the same rate as the other group.
Reading a study like this, it would be easy to throw up one’s hands and declare that you really can’t help some people — and that noncompliance simply isn’t something you can affect.
But then I ran across a second study. As the New York Times reports, “Getting women into medical care when they are only a few months pregnant is a top priority of public health officials, because simple interventions often save the lives of both mother and child.” But in Uganda, many rural women don’t go to the doctor before delivery, as it is seen as a waste of time. (And, presumably, money.) A smart group of providers set up an initiative to advertise prenatal care, specifically highlighting that through ultrasounds; women would be able to see pictures of their unborn baby. The results? 6 times as many women showed up than when ultrasounds were not advertised.
The contrast of the two studies validates something that I believe to be true: to develop a care plan or compliance approach, we need to start by understanding the experience and motivations of the people we are caring for. The simple ultrasound approach seems to have come from a deep understanding of the Ugandan mothers — not simply from the logic of a healthcare provider. The heart attack study, on the other hand, may have sounded like a great solution but seems not to be rooted in a real understanding of why heart attack survivors choose not to take their medication. Perhaps it’s not a lack of motivation or forgetfulness, but depression. Or despair. Or not truly understanding the course of treatment. In any of those cases, the pull-out-all-the-stops treatment really wouldn’t be a true treatment, regardless.
One of the things I love the most about iClickCare is that it brings the humanity back to medicine. I’m no longer treating a patient (one in a long list of them). I’m treating a person. And I’m no longer getting a voicemail from a faceless provider; I’m collaborating with a friend and colleague. I believe that this kind of medical collaboration can help us truly understand our patients and truly understand our colleagues. That way, when we act, when we prescribe, and when we intervene, we do so from a place of strength and a place of understanding.
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