Adherence
Chronic diseases - non-communicable diseases and mental disorders, HIV/AIDS and tuberculosis -- represented 54% of the world wide disease burden in 2001 and will reach over 65% of the burden in 2020. Treatments for these conditions involve long-term therapies that include:
- daily medication schedules
- regular monitoring
- dietary restrictions
- exercise
- other disease-specific requirements
But adherence to chronic disease treatments is estimated by the World Health Organization to average only 50% in developed countries and even lower for developing countries. "Adherence is a worldwide problem" their report declares. A report from Diabetes Care indicated that only 2% of diabetic adults in the US conform to the Diabetes Association's care recommendations. Asthma adherence rates have been reported as low as 30%. One HMO study reported that only 20% of patients filled four or more prescriptions of their anti-depressant within 6-months. The research is unequivocal - adherence problems exist in all situations where self-monitoring and self-administration is required.
Such adherence failure has an enormous impact on healthcare in both quality of life and economic terms. For severe asthma, optimal control would deliver an estimated 45% savings in care. The Office of the US Inspector General estimates that there are 125,000 deaths each year from cardiovascular disease that is due to non-adherence. Costs of health care related to hypertension and its complications accounted for 12.6% of total US expenditure on health care in 1998. Up to 23% of nursing home admissions, 10% of hospital admissions and countless doctor visits, tests and unnecessary treatments result from non-adherence.
The impact of even a minor adherence improvement could be enormous. One researcher emphasized the significance of adherence succinctly: "Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments."
An effective adherence system must provide:
- Education for patients, caregivers and their families
- Continuous assessment of current regimen effectiveness and adherence
- Self-management tools to aid patients in complying with their care plan
- Regular monitoring and feedback to patients and providers
There is a long history of intervention methods that have employed nurses and other caregivers to regularly reach out to patients -- home visits, phone calls, e-mails, etc. These interventions have often shown significant impact on the adherence rates of patients involved in such programs.
However, those resource intensive programs are only viable for limited populations who can afford such costly intervention. A global solution must implement other techniques that can mimic the benefits of these interventions affordably.
MedRespond's solution integrates the Custom Conversations into the long-term therapy to support the provider's messages. Programs can involve medical assessments to establish base lines, therapists to assess readiness to change, health educators to inform patients about risks and proper lifestyle management, personal coaches who help patients develop action plans, regular reminders and follow up, and more. Messages are continually delivered to the patient to reinforce their regimen and motivate them to comply with their doctor's instructions. The system becomes a tool for the treatment team to reach out to patients and monitor potential side effects or non-compliance concerns in the time between office visits.
MedRespond recreates the entire spectrum of human interaction to support chronic patient care. These solutions meet an enormous need in healthcare.
MedRespond Adherence support is a series of behavioral modification programs that help patients adhere to chronic care regimens. This consists of the following components of wellness care:
On-Demand Disease Education - educating patients about their disease, its progression, how it can be controlled and the importance of managing it.
On-Demand Treatment Education - each patient will receive specific instructions about their healthcare regimen. Specifics about the medicines they have been prescribed, the proper way to take their medications, side effects to be alert for and outcomes they should expect with proper care.
Interactive Coaching Sessions - WellRespond interacts with patients continually. The first step is to assess a patient's starting point then track how they progress. How they are doing? What issues concern them? How can you overcome difficulties with the disease? What do other patients suggest? Share patients' stories of success. Through regular patient contact, the patient is supported by friendly personal reminder to stay on their treatment plan and reinforce good treatment outcomes.
E-Reminders - Integrating the online technology to PDA's and cell phones, the system can remind patients about daily, weekly monthly events. When they should repeat an exam, when their prescription refill is up, and more.