Do patients need a medical mom?

The more I try to avoid the physician-parent analogy, the more it seems to stare me in the face. This week, it struck me while writing about a major study out of Brigham and Women's Hospital that revealed that even when heart-attack survivors receive free drugs to prevent future heart problems, fewer than half of them fill and take the prescription.

The researchers, looking to see if they could remedy the plight of one-third of patients who say they are noncompliant with medication adherence because of cost, were reportedly stunned that taking copays out of the equation resulted in only a 4 percent to 6 percent improvement.

In my way, I feel their pain. After all, the "disheartening" results sound an awful lot like my three-year-old insisting she can't wear the brown shoes because they pinch her toes. Or the black ones. Or her sneakers. Or anything other than the rhinestone encrusted slippers she recently saw on a princess doll in a store window.

Of course, medication compliance is a complex issue. In addition to costs, many medications come with unpleasant side effects, and remembering what to take and when poses a real challenge for some patients.

But figuring out how to motivate any behavior change at all in patients--to lose weight, to stop smoking, or any other similar change--remains the holy grail for a lot of frustrated physicians. Clearly, you can't make patients healthier if they don't cooperate. But with the luxury of patient face time diminishing by the day, what are the answers?

As we reported in a previous article about reducing no-shows, patients are less motivated to treat symptoms they can't feel or see (that article recommended visual aids to illustrate risks). While the memory of the first heart attack kept some dedicated to their regimens, the "out-of-sight, out-of-mind" phenomenon likely came into play for others.

According to an article in this week's Healthcare Finance News, patients surveyed by TeleVox Software said they'd do a better job following doctors orders if doctors checked up on them between visits. Out of the national sample of 1,015 consumers age 18 and older, 42 percent said they would do better following a treatment plan if they received encouragement between visits, and 35 percent said they'd do better if they received reminders via email, voicemail, or text to do things such as taking their medication. (Incidentally, 66 percent of my family members swear they'd never wake me up in the middle of the night again if I stayed curled on the edge of a toddler bed until dawn holding one of their hands.)

However, and I quote, Davis Liu, a California-based family physician who wrote Stay Healthy, Live Longer, Spend Wisely, said, "[I] don't think patients want to be babysat per se, but rather are [so] overwhelmed with choices, stress, etcetera, that sometimes doing the right thing is difficult."

And for patients that need just a little nudge, I don't doubt that the automated reminders that vendors promote would make a difference. As TeleVox president Scott Zimmerman pointed out, people are used to getting automated bill pay reminders, birthday reminders, meeting reminders, and so on. I don't know about you or your patients, but I sometimes hit "ignore" on a half-dozen of these friendly reminders before finishing my first cup of coffee.

So for patients who need more of a shove, a person likely needs to provide that reminder firsthand. An experiment underway in Maryland is testing the medical home model as a way to provide precisely that personal touch.

Again, I'm not making this up: "For a patient, it is like having a doctor's office that acts like mom--with nags and nudges designed to promote better health," reads the article in the Washington Post.

Despite all of the promise of the medical home model and expanding number of pilots rolling out across the country, even proponents acknowledge that making the transition can be extremely difficult for practices. Even with payers and more federal funding behind the concept, it will take some time before all physicians will be able to provide their patients this level of attention.

In the meantime, my advice: Stop wasting time pestering patients. Get them to agree to have those reminders sent to Mom. - Deb