Patient engagement is defined by the Center for Advancing Health
as “actions individuals must take to obtain the greatest benefit from the health care services available to them.” Certainly, such engagement is essential when it comes to one of the most important patient actions of all: taking medications. After all, as a Yoruba proverb says: “Medicine left in the bottle can’t help.”
The problem: Patients don’t seem to be fully engaged when it comes to taking medications. In fact, medication is not taken as prescribed 50% of the time. This non-adherence leads to 10% of all hospitalizations and 26% of all preventable readmissions. Medication complications also are responsible for 125,000 deaths per year in the United States. In addition to all these health consequences, the lack of patient engagement costs the U.S. health system up to $300 billion.
The big question: How can healthcare organizations get patients more engaged with their medication regimens? To start, healthcare providers need to truly understand who they are working with. The Patient Activation Measure (PAM) could help. PAM assesses a patient’s knowledge, skills, beliefs and confidence related to managing health and healthcare. As such, it categorizes patients into four levels of patient engagement:
Level 1: Disengaged and overwhelmed
- Level 2: Becoming aware, but still struggling
- Level 3: Taking action
- Level 4: Maintaining behaviors and pushing further
By using this assessment, healthcare professionals can reliably predict patients’ medication adherence as well as future emergency department (ED) visits, hospital admissions and/or readmissions, and more. A systemic review of studies between January 2004 and June 2014 using PAM measures among chronically ill populations, for instance, found that low stages of patient activation resulted in increased risk for hospitalization and ED visits.
Perhaps most importantly, though, after assessing PAM levels, healthcare professionals can then intervene with the patients who are not adequately engaged with their own care. Technology can help in this endeavor – as various solutions provide an efficient, cost-effective means for patients to engage in their health. Patients typically, however, only will act when the solutions are simple and intuitive.
FDB’s Meducation® is one example of the type of technology needed to elicit higher levels of patient engagement. Meducation automates the creation of simpler, patient-friendly medication instructions directly from the electronic health record (EHR). Instruction sheets are patient-specific, not generic, written on a 5th to 8th grade reading level, and available in more than 20 languages. Also, a visual medication calendar uses a proven methodology called the Universal Medication Schedule (UMS) for patients to easily understand and adhere to their medications.
The medication instructions are integrated into the EHR by using SMART (Substitutable Medical Applications, Reusable Technologies) on FHIR (Fast Healthcare Interoperability Resources), a set of open specifications to integrate apps with health IT systems. With these user-friendly instructions readily available, healthcare providers can help patients overcome the low-health literacy or language barrier challenges associated with understanding their medication instructions.
In a study at University of the Sciences, patients were more than twice as likely to read Meducation patient-specific sheets over the standard static sheets, which led to a 52% increase in medication adherence. Technology such as Meducation is an example of building a patient-centered solution to help patients engage with their medication regimens in a way they can understand to improve adherence and outcomes.
And, that means that patients will be much more likely to twist the cap, take the medications out of the bottle and use them as instructed – thereby improving their health and well-being.
About Charles Lee, MD
Dr. Charles Lee has advocated to reduce disparities in access to health information for underserved populations since he immigrated to the U.S. with his Korean family at age seven. In 2001, Dr. Lee founded Polyglot Systems, recently acquired by FDB, and invented Meducation®, a cloud-based technology that enables providers to create personalized patient medication instructions in more than 20 languages, including drug, dose and time of day. Currently Dr. Lee is Senior Director, Clinical Knowledge – Meducation, for First Databank (FDB).