How to get your patients on board with disease management

It’s frustrating when patients don’t follow recommendations. These tips may get them on track.

Three F’s of patient motivation: Fear, finances, and feeling better. 

Fear is a powerful, but temporary, motivator. A patient whose relative just got cancer is very open to screening. Another strong incentive is finances: money matters! Patients eagerly book well exams or adopt better behaviors to earn discounts on insurance premiums. A more encouraging reason for change is feeling better. 

More from First Take: Medical records belong to patients. PeriodMotivational interviewing. Inquire about readiness to change. Patients contemplating or preparing for change are receptive to advice. Have patients rate, on a 1 to10 scale, the importance of an intervention, and their confidence to carry it out. Their answers reveal barriers to abolish through creative problem solving.

Lead with lifestyle. For new metabolic diagnoses, I offer a three-month to six-month trial of diet and exercise before medications. To raise confidence, I discuss the patient’s past successes, similar patients’ achievements, or my personal benefits from healthful habits. We set realistic goals, and involve allied professionals such as diabetes educators to explain what to do, and why. 

Your Voice: MOC logic doesn't add up

Counter fallacies with facts. Patients say: “I can do it alone with diet” or “I only want natural remedies.” If they don’t reach goal with healthful habits, I praise their efforts but point out they can’t escape all genetic risks. I’ll consider plausible alternative medicine along with traditional treatment. Education about benefits, risks, and guidelines often requires multiple visits.

Next: Simplify, harnessing your EHR

Simplify. Stop unnecessary prescriptions. Consider affordable generics and once-daily medication doses. Make testing easier with one-stop lab and imaging. 

Remote patient monitoring: Fulfilling its promise

Harness your EHR. Most EHRs have population management tools: disease registries with automated letters, phone, or Web messages to patients with care gaps (uncontrolled metrics, overdue tests or appointments). Our practice is re-engaging people previously lost to follow-up through our product. 

Innovate! Our hospital-owned medical group employs two quality improvement nurses to compile disease management statistics and brainstorm improvement strategies that are disseminated to all sites. Internist James Lengemann, MD, my group’s medical director, piloted a half-day diabetes clinic when usual care wasn’t budging his worst-controlled diabetics. He implemented point-of-care testing and brought in diabetes educators. With focused attention, patients achieve better control and the clinic has expanded to two mornings per week with more providers. Nationally, telehealth is becoming popular. Evidence is limited for its effectiveness on adherence, but it’s worth trying with tech-loving patients.

Online tools can help PCPs aid patients traveling abroad

Pre-dismissal letters. When earlier outreach fails, I write a warning letter to express my concern for the patient’s health. I state that their nonadherence is weakening the physician-patient relationship so I can’t effectively help them. I set a clear goal, e.g. labs and a visit within six weeks, and warn that my next regretful step would be dismissal from practice with 30 days of emergency care until they find another doctor. This has brought nearly all my delinquent patients back into the fold.  

Elizabeth Pector, MD, is a family medicine physician based in Naperville, Illinois, and a member of the Medical Economics editorial advisory board. What strategies do you employ to increase compliance? Tell us at [email protected]