Electronic Health Reporter

By Poornima Venkatesan, senior consultant, Virtusa.

In today’s value-based care environment, patient engagement is a vital key to success in clinical outcomes. This is especially true for chronic diseases such as arthritis, where continuous care is necessary because of the disease’s physical, emotional and economic impact on patients. Although the advent of specialty drugs in the past decade has made disease control possible, clinicians still face challenges in patient care because patients’ preferences about therapy aren’t often considered.

Understanding patient goals and expectations

While a clinician’s goal is to achieve remission, a patient’s goal could be clinical or nonclinical and varies depending on their individual characteristics and demographics.

Patients from low-income countries such as Morocco expect access to primary care (never mind rheumatologists), support services and education about the disease. The high expenses related to rheumatoid arthritis (RA) in such countries result in poor treatment compliance, school absenteeism in children and deterioration in quality of life. Comparatively, even with excellent health insurance systems in the United States, one in six adults with RA reduce their medication use because of high out-of-pocket costs. Most patients expect cost-effective care. In wealthier countries like the United Kingdom, patients expect increased social connectedness and family support.

Elderly patients expect reduced pain, fatigue and side effects, whereas young adults expect independence and normalcy from their treatments. Women, who are most affected by RA, might expect a lesser impact on family life and childrearing.

If such multidimensional expectations are not met, patients tend to discontinue their treatment. As new biologics and non-biological complex drugs (NBCDs) are developed, patient adherence is essential in determining both therapeutic and potential adverse effects. Studies reveal that frustration towards the method of drug administration (like self-injection) also impacts adherence. In the U.S alone, the total cost of non-adherence is estimated between $100 billion and $289 billion annually.

Therefore, it is important for the patient and the physician to trust each other and have open discussions about treatment strategies and expectations to ensure better alignment and cooperation.

Measuring patient engagement

The first step towards patient engagement is awareness of their current engagement levels. The patient activation measure (PAM) tool is helpful here. PAM measures the attitude and knowledge of patients about the disease and treatments. Studies have proven that highly activated patients have better outcomes via increased medication adherence, resulting in lower healthcare costs through fewer ED visits, hospital admissions and re-admissions. By continuously monitoring activation levels, providers can measure sustained changes in patient behavior and personalize their care programs.

We can also measure engagement levels by taking advantage of data. Data derived from direct [electronic health records (EHR), claims] and indirect sources (wearables) provide a holistic view of an individual patient. Simple analytics applied to population data can predict patient behavior. For example, analytics can help providers know which patients are likely to miss their appointments, which patients will fill their prescriptions on time, and so on. Detailed patient-based data could also lead to better and more accurate diagnoses and treatments.

For more than a decade, EHRs have helped in clinical decision support and better guideline adherence. Research shows that using EHR data to provide a visualization of disease activity parameters to RA patients reduces their disease activity 28 (DAS28) score and significantly improves medication adherence. Using machine learning, EHRs can pre-populate information relevant to an encounter in real time based on patient data, creating opportunities for more effective care.

Digital healthcare engagement

For chronic conditions like RA, it is necessary to assess and monitor patients outside physician visits. That’s where technology can come into play.

A research paper presented to the American College of Rheumatology shows that “a 12-week digital health coaching program improved well-being and decreased symptoms for participants with RA.” Incorporating digital remote patient coaching tools into clinicians’ workflows can also support patient experience and monitoring and healthcare utilization.

Since long-term chronic disease management requires intensive self-efficacy and self-management, developing assistive tools can actively engage RA patients in the home monitoring of disease and treatment parameters. In the not-so-distant future, natural language programming (NLP)-aided chatbots will interact with patients; ask questions about their lifestyle, symptoms and treatment outcomes; collect their responses; help them in self-assessment and provide follow-up actions every day to help measure a patient’s resilience in real time.

Conclusion

Patient engagement benefits all the players in the healthcare ecosystem. It saves undue expenses for insurers, reduces absenteeism for employers via increased productivity, eases stress and helps in therapeutic decisions for physicians and improves outcomes for patients.

Technology is only one side of the coin, though. Understanding a patients’ life situations and priorities and motivating them always requires a human touch.