Food for Thought, part 2

As we continue with this month’s lifeskill, Meals, wellness also has everything to do with the four basic applications—taking care of your body (hygiene, quality nutrition, movement/exercise, and stress management). Also add quiet time, wholesome fun & laughter, and a vibrant spiritual-faith life.

Let’s look further into a comprehensive literature review and practitioner insights with Treatment Adherence in Integrative Medicine, by Integrative Medicine, A Clinician’s Journal in collaboration with FullScript (Special Edition (Vol. 20, No. S2). Let’s focus on what both provider and patient need to bring to the table.

First, providers have their own challenges to improve patient-provider relationships and outcomes. Yet, the patient’s low treatment adherence is a significant issue, limiting the effective management of chronic conditions. Low adherence also creates a significant healthcare burden, costs, and poor patient outcomes.

As also noted previously, there are hundreds of barriers identified, depending on stages of disease management. The primary adherence barriers are Practitioner/patient education, Overall cost for both patient and practitioner, Likelihood of adherence through complex interventions, Patients’ feeling overwhelmed, and not ready to change. Although there does not seem to be a clear solution to solve treatment non-adherence, particularly with complex chronic diseases so prevalent, let’s see what both provider and patient can do to improve doctor/patient outcomes.

What Providers Bring to the Table

When doctors provide a personalized approach to understanding, identifying, analyzing, addressing, monitoring, and evaluating the reasons for non-adherence and the strategies, we as patients may just come away with a greater commitment to treatment plans. Along with establishing trust, providers need to maintain:

  1. Realistic cost along with insurance coverage options, using a staged approach to introduce treatments one at a time and set realistic goals in line with financial restrictions.
  2. Patient readiness by assessing the likelihood a patient will adopt a behavior by asking open-ended questions about motivations, attitudes, and beliefs about treatment (e.g. motivational interviewing and evidence-based strategies communicating empathy and a shared partnership/investment in a patient’s wellbeing).
  3. Education to reassure the patient with education-based treatments and how they work, potential side effects, information about the condition, and adherence importance. Use lab testing to help demonstrate the need for treatment and track progress.
  4. Staged approach enabling simplified treatment regimens and multiple options for increased flexibility (e.g., reduced dosing frequency-e.g. sustained-release, fewer therapies-e.g. combined pills, pill organizers, treatment linked with simple daily habits). Be clear on what has priority.
  5. Multiple communication options  as treatment reminders, such as text messages, phone calls, telehealth, applications, in-between appointment follow-up, adherence feedback using quantitative and qualitative data.
  6. Streamlined Integration of care by involving other practitioners with various training, schedule flexibility in the process or provide referrals. Incorporate multiple strategies such as behavioral, educational components for long-term adherence, and adherence training as a professional development opportunity.

What Patients Bring to the Table

If we are honest with ourselves as patients, we still cling to those adherence barriers of not educating ourselves, managing our finances to cover healthcare costs, adhering to complex interventions, feeling overwhelmed, and we are often not ready to change. That is what many of us still bring to the table.

One key area conventional and many integrative medical providers are beginning to get the message is Group Delivered Care. If you have not heard of this, its time has arrived. With the help of healthcare advocates and proactive patients this kind of care is beginning to come to the table to help doctors improve their practice on behalf of us all.

As patients share their stories and become more proactive on what they want from their doctors, we will all contribute to everyone’s wellbeing. I remember on many occasions over the years my doctors actually gave my contact information (with my permission) to other patients to hear my story as a way to encourage, offer hope & share options that worked for me. That was the beginning hints in my journey to publish my story and become a professional lifeskills/wellness coach.

According to James Maskell, HealCommunity CEO, a passionate advocate for more effective chronic disease care focused on prevention and reversal, describes what group delivered care looks like:

  • Accountability is critical to behavior change, but patients often lie to their doctors. By creating accountability between peers, more vulnerable, honest interactions occur.
  • Mentorship has been critical to the success of Alcoholics Anonymous, and uniquely, the process of mentorship is valuable to both the mentor and the mentee. In any group, variations of experience and success naturally occur, leading to opportunities for informal support and mentorship.
  • Credibility occurs when people meet other people just like them who are on the path to health. What if every person with a chronic illness could meet someone who had overcome a similar condition?
  • Education is much more efficiently delivered in groups. The didactics are delivered one to many, but then powerfully reinforced as participants share their own experience within the group. One person’s lessons can be learned by everyone in the group.
  • Community with social stress and loneliness being the most powerful drivers of all-cause mortality, introducing isolated people to each other in an empowering and supportive context is great medicine.

One consistent theme heard from clinics who offer group delivered care is wellness or health coaches are well suited to hosting these groups. “Coaches stay within their scope of practice more easily by engaging the group when questions come up. For some medical professionals, who have been valued their whole career for their knowledge, the temptation in the moment to ‘have the answer’ overwhelms their desire to empower the group.”

Does your doctor offer these listed interventions? Before you talk with your doctor, first ask yourself, “Am I ready to do what it takes?” That means staying with it throughout your life seeking, reaching, and achieving your highest wellness potential.

If you want to be part of a Zoom life/wellness mentoring support group I am forming, simply contact me, and I will send you sign up information.
I look forward to helping each other on our wellness journey.