- Healthcare professionals looking to support better chronic disease management and improved medication adherence should consider another tool in their arsenal: nurse-led health coaching.
The healthcare industry has long been chipping away at the overarching challenge of chronic disease management. Principle among those issues is medication adherence, a trend whose per-patient costs range anywhere from $950 to $44,190 each year, some studies estimate.
But getting patients to take their medications is easier said than done. Healthcare professionals often lack the data needed to help patients manage their medications, and patients with multiple medications or complex regimens have trouble keeping track of their pills.
Numerous technologies have been developed to address these issues, yielding varying degrees of success, according to Peter Goldbach, MD, chief medical officer for Health Dialog, the population health management arm of Rite Aid Pharmacy.
Health IT developers are chipping away at the data interoperability issue that keeps prescribing providers and pharmacists from being on the same page. Additionally, a culture of patient-centricity is prompting these stakeholders to utilize technology to communicate better.
Additionally, consumer-facing technology is helping to nudge patients toward better medication adherence. Medication management apps, reminder alerts, and other engagement tools are helping patients keep track of their own medications.
But technology is not a panacea, Goldbach explained, and patients need interpersonal interactions inside the pharmacy to help supplement these technology-based efforts.
“It's been made clear that we all respond to prompts in our environment,” Goldbach said in a recent interview with PatientEngagementHIT.com. “There are programs that can be based on things like texting people, but what we're highlighting is the fact that – especially for people with chronic illness that are facing challenges like depression, or transportation, or complexity of medication regimens – that these interpersonal, trusted interactions with a nurse tend to be very effective.”
Consumer-facing technologies and medication reminder apps are not a bad thing, Goldbach clarified. But health coaching can add another layer to those approaches to create more dynamic chronic care management.
Using health coaching strategies allows pharmacy nurses to create a truly patient-centered experience that is unique to each individual healthcare consumer. Instead of asking a patient to make a technology work with her lifestyle, health coaching takes a look at that patient’s lifestyle and determines what interventions complement it, Jill Goodspeed, Health Dialog’s director of health coaching services, added.
“Our approach is to really focus on understanding the individual and what their personal preferences and barriers and what type of support system they have in place,” Goodspeed explained.
For example, Goodspeed and her colleagues recently encountered a patient who experienced two major heart attacks in two months. This patient needed to be taking heart medication, but his medication adherence was low.
Through health coaching sessions, Goodspeed and her team were able to determine that this patient did not need better engagement technology or data interoperability between his doctor and pharmacist. What he and his wife, who served as his caregiver, needed was a ride to the pharmacy.
“His wife was staying at home and taking care of him 24 hours a day because he needed 24-hour care,” Goodspeed recalled. “She didn't have an opportunity to actually drive to the pharmacy and pick up his medication. In this case, we used our partnership with Rite Aid, our parent company, to offer delivery medications.”
Cases like that underscore the true importance of health coaching, Goodspeed and Goldbach agreed. While better data and strong engagement tools certainly do not hurt medication adherence, it is the human touch of health coaching that can complete the circle and support patient behavior change.
“Simply by taking the time to understand what this gentleman's situation was, getting his wife engaged in the conversation, and having her explain that the barrier was getting the medications, we could set up the delivery,” Goodspeed said. “This gentleman is now adherent to taking his medication. That's really applying what we have taught our staff to take a moment and stop and understand who that individual is and what is their unique situation, and what are their barriers.”
Not all patients are so easily able to discover or articulate their medication adherence barriers, Goodspeed added. Some patients don’t always know the true reason why they aren’t taking their medications, or for whatever reason do not want to share those reasons.
In these cases, health coaches must use their patient-provider communication skills, open-ended questions, and other patient motivation techniques to get to the bottom of the situation.
Goodspeed advocates for the Ready, Set, Go, technique Health Dialog offers.
During the Ready stage, staff members assess what patients know about their conditions, their ability to engage with their treatment plans, and their readiness to make behavior change. For example, it is ineffective to introduce an adherence intervention if a diabetic patient doesn’t understand his condition or is in denial about his health.
When the patient is not ready for an intervention, health coaches probe further to find a patient’s intrinsic motivation to live a healthier life. Health coaches must be patient and wait for healthcare consumers to come to realizations on their own.
After the Ready stage comes Set, during which health coaches prepare patients with the information necessary to succeed in a medication adherence intervention.
“During the Set stage, we evaluate the likelihood the patient will take the desired action on that we need from them to make a change,” Goodspeed explained. “It's really passing along the education to the patient, coming up with what the action plan to address barriers, and then we schedule follow up calls for individuals.”
After that it’s Go time, Goodspeed said. Health coaches monitor progress and make adjustments where necessary.
Health Dialog has employed health coaching for just two years, but already the organization is seeing positive results, Goodspeed reported. Patients who have received health coaching yield a two to seven percentage point increase in medication adherence.
More patients are also achieving 90-day adherence for their chronic care management medications – 15 percent more for diabetic patients and 20 percent for patients with hypertension.
While Goodspeed and Goldbach both acknowledge the roles of better data, strong patient engagement technology, and other care management tools such as pill packaging, they assert that health coaching is also an integral part of their strategies.
“It does seem that behavior change is really helping in conjunction with all of these other things like pill packing and medication management,” Goodspeed said. “We all have to work together to achieve effective medication adherence.”
Ultimately, it’s health coaching that puts all other medication adherence strategies into context, Goldbach explained. Health coaches play a supporting role in the patient’s health journey, empowering the patient to better understand her health.
“Part of the coaching interaction with a patient is helping her understand how she can work better with her doctor,” Goldbach concluded. “It's very challenging to be sick, to have multiple illnesses, to be on complicated regimens. Providers are very busy people, so we play a supportive role. We use nursing to help people understand how to better take care of themselves.”