Post on 15-Jan-2016
Patient issues that get in the way of TX adherence: surprising survey findings
Sue BergesonVice President Consumer Affairs OptumHealth Behavioral Solutions
Who Am I?
The Art Work
The Context It’s tough out there Assume passion and commitment There is no blame We are each expert in our own
arena
At the end of this presentation, participants
will:•Learn how to improve patient satisfaction, based on the results of a large patient-based surveys
•Be able to enhance patient engagement; and treatment adherence in their primary care behavioral treatment;
•Learn how to optimize treatment results in a limited-visit situation;
•Be familiar with the role and benefits of a peer specialist
Communication Challenges
Face to Face Time: Seven Minutes
What would you like to see changed? N=3,662
Spend more time with me; don’t rush through my appointment
PCP: second highest responsesecond highest responsePsychiatrist: highest response OBY/GYN: highest response
Time Before Interruption: ?
Time if Not Interrupted: ?
Strategy ListAllow the two minutes of patient conversation before interrupting, I will leave not feeling rushed and will have the chance to commit more fully to the treatment regime
Experienced vs Communicated
78% Erratic sleep
77% Heighten mood,
75% Racing thoughts
74% Racing speech, impulsiveness
72% Poor judgment,
67% Irritability
57% Reckless behavior
57% Erratic eating
56% Erratic sleep
36% Heighten mood
43% Racing thoughts
37% Racing speech, Impulsiveness
35% Poor judgment
40% Irritability
26% Reckless behavior
26% Erratic eating
Stigma – Alive and WellInternal
• Patients were asked about their reactions when they were first diagnosed with depression. A minority reported having negative feelings, including being afraid (33%), embarrassed (26%), angry (21%) or stigmatized (20%). (DBSA Primary Care Survey 2000)
• However, the vast majority of persons with depression report that when their condition was first diagnosed as depression, they felt relieved to know what was wrong (59%) and glad their condition could be treated (70%). (DBSA Primary Care Survey 2000)
• Almost three-quarters (71 percent) of the respondents said that they would ask their doctor to prescribe treatment. And few felt that they would lose their job (17 percent), lose friends (17 percent), or feel like they have no one to talk to about it (14 percent). (NDMDA Gallop Pole Public Phone Survey (2002)
• Just over one-fourth (26 percent) said they would neither worry about these things nor seek treatment. In general, older adults, those with college experience are the least concerned about being stigmatized. Those with the least education are the most concerned (NDMDA Gallop Pole Public Phone Survey (2002)
• Most survey participants did not consider themselves knowledgeable about depression or bipolar disorder. Thirty-six percent said they were very or somewhat knowledgeable about depression (NDMDA Gallop Pole Public Phone Survey (2002)
• 50% most frequently associated depression with sadness (NDMDA Gallop Pole Public Phone Survey (2002)
• While many did understand the need for medicine to treat mood disorders, nearly three-fourths (74 percent) believed that medications change the patient’s personality. In addition, over two-thirds (67 percent) believe the medications are habit-forming. (NDMDA Gallop Pole Public Phone Survey (2002)
• Concern for a potential diagnosis of depression was much lower than concerns for other major diseases.(NDMDA Gallop Pole Public Phone Survey (2002)
Strategy ListAllow the two minutes of patient conversation before interrupting
Explain the illness and its importance and impact in consumer words
Address our fear of medication upfront
Explain your Illness to your satisfaction?
No: Psychiatrist 47%, PCP 63%
Explain your treatment to your satisfaction?
No: Psychiatrist 48%, PCP 57%
51 % Still wanted more information about their mental illness
Less than half of respondents had been given written information
81% who were given information - very useful
Communication Challenges
Strategy ListAllow the two minutes of patient conversation before interrupting
Explain the illness and its importance and impact in consumer words
Address our fear of medication upfront
Provide us with information we can read written in consumer language
Stigma – Alive and WellExternal
• One-fourth believe that people with mood disorders are dangerous, can be easily identified in the work place, and are not able to form and maintain long-term, stable relationships.
• One out of five believe people with mood disorders should not have children..
• One-fourth disagree that people with mood disorders live normal lives and function well and work and at home.
• All things being equal, about half (48 percent) of those surveyed would not vote for a candidate for national office who had once been diagnosed with clinical depression (24 percent would not vote for the candidate and 24 percent might or might not vote for the candidate).
• Nearly the same percentage (49 percent) agreed that people with mood disorders are not stable enough to hold positions of authority.
• In general, older adults, men and the less educated and minorities were more likely to support the stigma associated with mood disorders
• More females than males believe in the efficacy of medication as well as the ability of people with mood disorders to lead normal lives.
Source: NDMDA Gallop Pole Public Phone Survey (2002)
Strategy ListAllow the two minutes of patient conversation before interrupting
Explain the illness and its importance and impact in consumer words
Address our fear of medication upfront
Provide us with information we can read written in consumer language
Address the shame of mental illnesses directly in conversation
Primary Care Survey N= 2,000 – both consumers and providers
PCPs 71% say they make joint decisions, but
Only 39% say doctor asked their preferences
PCPs 69% say they tell side effects, but
Patients, only 16% told
When you were prescribed medication, what did your doctor
tell you to expect?
Strategy ListAllow the two minutes of patient conversation before interrupting
Explain the illness and its importance and impact in consumer words
Address our fear of medication upfront
Provide us with information we can read written in consumer language
Address the shame of mental illnesses directly in conversation
Explain what the meds will do and what I should watch for
Relevance
Recovery goals vs. Treatment goals
Psych Nurse example
Feel Bad Take Meds Feel Better
Feel Hopeless/Worthless Change Life Feel Better
…isoverwhelmed
by
Five Stages in the Recovery Process
…is moving beyond
…hasgiven in
to
…is challenging
…is questioning
Impact of Diagnosis Life is Limited
Change is PossibleActions for Change
Commitment to Change
There are times when a person...
…the Disabling Power
of a Psychiatric Diagnosis
Five Stages in the Recovery Process Impact
ofIllness
The person is overwhelmed and confused
by the disabling
power of the illness.
The task is to decrease the emotional distress by
reducing the symptoms.
Life is
LimitedThe person has given into the
disabling power of the illness and is not ready/able to make a change.The task is to instill hope, a
sense of possibility, and to rebuild a positive
self-image.
Changeis
PossibleThe person is beginning to question the
disabling power of the illness and
believes that his/her life can be different.
The task is to empower the person
to participate in his/her recovery by beginning to take
small steps.
Commitmentto
ChangeThe person is
challenging the disabling power of the illness and is willing to explore what it will take to
make some changes.
The task is to help the person identify his/her strengths
and needs in terms of skills, resources
and supports.
Actionsfor
ChangeThe person is
moving beyond the disabling power of the illness and is willing to take
responsibility for his/her actions.
The task is to help the person use
his/her strengths and to get the necessary skills, resources and
supports.
Strategy ListAllow the two minutes of patient conversation before interrupting, I will leave not feeling rushed and will have the chance to commit more fully to the treatment regime
Explain the illness and its importance and impact in consumer words
Address our fear of medication upfront
Provide us with information we can read written in consumer language
Address the shame of mental illnesses directly in conversation
Explain what the meds will do and what I should watch for
Link my treatment to my recovery goals/what I care about
Consumer Perceptions: What We Really Want
consumer family member
1
To be treated with respect
Doctor nurse or therapist who listens to my family member (tie) Thorough explanations of what is going on
2
Doctor nurse or therapist who listens to me
Treatment that looks at my family member's whole life not just medication
3
Treatment that looks at my whole life not just medication
Treatment that builds on my family member's strengths instead of just focusing on the illness (tie) Care that provides hope
4
Thorough explanations of what is going on
Options other than hospitals when my family member feels bad
5
Treatment that builds on my strengths instead of just focusing on the illness (tie) Care that provides hope
Easier access to the medications my family member's doctor prescribed (insurance won’t pay or wants my family member to take something else first or I can’t afford the medication)
DBSA Survey 2004 N=2,000
Link consumer to peer resources
John Rush, MD, DBSA support group participation fewer hospitalizations, greater adherence
Mark S. Salzer, Ph.D., mental health self-help groups are associated with decreased symptoms, increased coping skills, increased life satisfaction, and greater adherence
Peer Specislits as a Resource
Certified Peer Specialists aka Recovery Coaches in Primary Care Settings
Surgeon General – power of peer support
President’s New Freedom Commission 2.2 Role of peers in service delivery
Institute of Medicine Report Increasing role of peers in recovery
Annapolis Coalition Report on the Behavioral Health Workforce Goal One
CMS Acknowledgement as EBP
Certified Peer Specialists / Recovery Coaches Roles in Primary Care:
Time: Warm Hand Off (Heart)
Psychosocial Education: Druss/Lorig, Living Successfully (Baby)
Stigma Reduction (Corrigan)
Adherence/engagement: WRAP, Support groups, community engagement, Mood
charting, follow up
Whole health, smoking cessation groups, soft exercise, diet, stress management
Post Hospitalization Bridge
Hope
Certified Peer Specialists / Recovery Coaches
Georgia Research:
Overall, peer support consumers showed improvement as compared to control group in each three outcomes over an average of 260 days between assessments
Current symptoms/behaviors
Skills/Abilities
Resources/Needs
Strategy ListAllow the two minutes of patient conversation before interrupting, I will leave not feeling rushed and will have the chance to commit more fully to the treatment regime
Explain the illness and its importance and impact in consumer words
Address our fear of medication upfront
Provide us with information we can read written in consumer language
Address the shame of mental illnesses directly in conversation
Explain what the meds will do and what I should watch for
Link my treatment to my recovery goals/what I care about
Encourage participation in free peer support groups
Consider hiring a CPS for your practice
1. Listen2. Communicate3. Compassion (tied)3. Knowledge (tied)4. Interpersonal Skills5. Attitude of Respect6. Skill7. Allow enough time8. Work in partnership with us9. Don’t just medicate10. Look at the whole person
DBSA /NAMI Survey: What we want from our providers:
DBSA Survey 2004 N=2,000
I want the health care system to:
1. Give me hope/seem hopeful about my future
2. Let me make decisions / have some input into my treatment & care
3. Focus on my wellness not my illness
4. Act in a way that shows they believe that I can recover
5. Listen to what I need instead of telling me what I need
Thank YouSue Bergeson
Vice President
Consumer Affairs,
OptumHealth
Behavioral Solutions
Susan_R_Bergeson@uhc.com