Adherence And Persistence Programs

For many chronic diseases, treatment outcomes largely depend on the active participation of patients in their treatment(Demoly et al. 2016). However, as ChesneyMargaret points out in Volume 30 of the Clinical Infectious Diseases of June 2000, nonadherence to medications remains widespread among patients with chronic diseases. This is widely evident in clinical practice and trials worldwide.  

Researchers have determined that patients fail to keep up with their medication or treatment plans because of forgetfulness, perceived lack of efficacy of the medication and many other reasons. More specifically, a report published by the American Medical Association identifies fear of potential side effects as a critical reason for intentional nonadherence. The report further says that the cost of medication, lack of understanding of the need for medication, delayed results and the nature of side effectsalso have an impacton adherence to medication.

Since most treatment regimens may not be successful without patients’ active participation, interventions that encourage adherence are key to achieving better treatment outcomes and improving people’s quality of life overall. These should cut across scheduling of appointments for patients and dose reminder calls,to designing of customized adherence plans for different patients.

References

Chesney, M.A., 2000. Factors affecting adherence to antiretroviral therapy. Clinical Infectious Diseases30(Supplement_2), pp.S171-S176.

Demoly, P., Passalacqua, G., Pfaar, O., Sastre, J. and Wahn, U., 2016. Patient engagement and patient support programs in allergy immunotherapy: a call to action for improving long-term adherence. Allergy, Asthma & Clinical Immunology12(1), p.34.

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Affordability Models

Patients and members of the general public are generally more willing to pay for healthcare services and interventions that they consider to be of higher or greater value. The more highly valued the healthcare intervention, the more willing people will be to pay for it(Smith & Cunningham2004). However, the high cost of treatment remains a major challenge for patients worldwide. Diagnosisof diseases like cancer, for instance, can bring with it substantial financial worries for many patients, with nearly 75 percent of cancer patients reported experiencing subjective economic distress(Yezefski et al. 2017). 

In the Seminars in Hematologypublication, Todd Yezefski and colleagues observe that High out-of-pocket spending on cancer drugs, like for most other chronic diseases, is known to contribute to financial problems among patients, with these costs seemingly only increasing. This apparently underscores the glaring importance of enhancing access to medicines by making them more available and affordable, though this goal remains a major global public health challenge.

One of the best ways to address this problem is to coordinate between patients, payers and pharmaceutical manufacturers and design tailored “Shared Contribution Models” that address particular barriers to treatment financial affordability. This should involve manufacturers, distributors, and pharmacies to warrant a seamless and timely patients’ access to their treatment in accordance with various local and global regulations guiding the practice.

References

Smith, A.S.A., and Cunningham, S.J., 2004. Which factors influence willingness-to-pay for orthognathic treatment?. The European Journal of Orthodontics26(5), pp.499-506.

Yezefski, T., Schwemm, A., Lentz, M., Hone, K. and Shankaran, V., 2017, September. Patient Assistance Programs—A valuable, yet imperfect, way to ease the financial toxicity of cancer care. In Seminars in Hematology. WB Saunders.

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Care Pathway Management

The process followed in the treatment of a particular disease significantly determines the patient outcomes. The process depends on the nature of the condition or specific needs of the patient. It is important to optimize this process, otherwise referred to as care pathway, by improving the quality and efficiency existing in healthcare, cooperation between healthcare professionals and eventually patient satisfaction. According toAgarana& Olokunde (2015), care pathways help health professionals to identify the right steps to take during treatment, largely because healthcare needs are unique to each patient.

Optimizing the care pathway often comes with the challenge of unclear cost-effectiveness even as new technologies offerthe promise of improved outcomes.De Vries et al. (2007) also identify co-morbidity, cognitive impairments, poly-pharmacy, emotionalproblems, sensory impairment, functional limitationsand lack of social support as some of the problems that medical and nursing staff in oncology for older cancer patients face in their care pathway management process.

Although there is no one-size-fits-all solution for thechallenges facing clinicians in optimizing the care pathwaytoday, Brufsky& Lokay (2013) found in a study that clinical pathways program rooted in patient-specificWeb-based decision support tool can help reduce unnecessary variability and drive adherence to evidence-based medicine eventually decreasing the growth in cancer care costs.

References

Agarana, M.C., and Olokunde, T.O., 2015. Optimization of Healthcare Pathways in Covenant University Health Centre Using Linear Programming Model. Far East Journal of Applied Mathematics91(3), p.215.

Brufsky, A. and Lokay, K., 2013. How to develop and deliver pathway-based care. Hematology/Oncology Clinics27(4), pp.843-850.

De Vries, M., van Weert, J.C., Jansen, J., Lemmens, V.E. and Maas, H.A., 2007. Step by step development of clinical care pathways for older cancer patients: Necessary or desirable?. European journal of cancer43(15), pp.2170-2178.

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Caregiver Support Programs

To improve treatment outcomes and overall quality of life is often the primary goal of any treatment plan for people with chronic or life-changing health conditions. Being associated with severe effects on the patient’s quality of life and high rates of nonadherence, treatment outcomes of these diseases heavily depends on the level and quality of support the patients get. Caregivers play a critical role in providing their sick family members with the required support in the form of physical, emotional and moral care.

According to Lloydet al. (2017), patients of such diseases as schizophreniathat require long-term treatment can experience a better quality of life with antipsychotic medications which tend to ameliorate some symptoms over time, though individual responses differ. There are those who will discontinue medication because of debilitating side effects or poor efficacy. In such cases, caregivers provide the much-needed support to ensure the patient follows through with the recommended and treatment plan as agreed upon by both the patient and the physician.

Caregiversupport programs are therefore crucial as they provide caregivers with the training, educational resources, and multiple tools they (carers) need to perform their role successfully.

References

Lloyd, J., Lloyd, H., Fitzpatrick, R. and Peters, M., 2017. Treatment outcomes in schizophrenia: qualitative study of the views of family carers. BMC Psychiatry17(1), p.266.

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Customized CME Programs

Research has indicated that continuing medical education has the huge potential to improve physician performance. In a 2015 study published in the Journal of the American Academy of Dermatology, a group of researchers found that the CME activity under study led to significantly improved documentation of patient’s history, shared decision making and patient counseling for lifestyle behaviors among the medical practitioners in the study population. Continuing medical education generally consists of educational activities that serve to maintain, develop and/or increase a physician’s knowledge, hone their skills, and improve their professional performance. CME also improves the way physician relate with patients, fellow professionals and the public as they provide services.

According to the Keck School of Medicine USC, continuing medical education utilizes materials and events that address professional practice gaps in the community while fostering physicians and other practitioners’ continuing professional development. It enables individuals to satisfy licensure requirements and eventually leads to improved outcomes in patient health care.

Effective CME programs must provide relevant, evidence-based medical education within various clinical focus areas. This may entail the application of educational best practices and modern technology to optimize the development of the knowledge, skill-set, and building capacity that healthcare professionals require in order to perform safe and effective patient care.

References

Davis, N., Davis, D. and Bloch, R., 2008. Continuing medical education: AMEE education guide no 35. Medical teacher30(7), pp.652-666.

Gist, D.L., Bhushan, R., Hamarstrom, E., Sluka, P., Presta, C.M., Thompson, J.S. and Kirsner, R.S., 2015. Impact of a Performance Improvement CME activity on the care and treatment of patients with psoriasis. Journal of the American Academy of Dermatology72(3), pp.516-523.

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