When it comes to chronic diseases like diabetes, medication non-adherence is common and costly. In fact, over 50% of patients stop taking their medication within the first year. Non-adherence causes poorer treatment outcomes, which in turn leads to increased health care utilization and hospital admissions. Basically, when patients drop off their medication, the results are harmful to the patient and costly to the healthcare system.
Why is it so hard for patients to self-manage and stay on their care plans?
The answer is that chronic diseases are complicated, especially diabetes with its complex medical regimens and required lifestyle changes including blood sugar checks, exercise, and nutrition. On top of that, as we know, people are complicated. According to the Institute for Clinical System Support, 80% of an individual’s health is determined by behavior and socioeconomic conditions, both of which can vary greatly from person to person.
From our experience working with diverse patient populations (urban and rural, English and Spanish speaking, different socioeconomic backgrounds) we have learned that each patient deals with their unique barriers in their own way.
Some may be in denial of their diagnosis or scared of injecting, while others are injecting, but doing so incorrectly. Others have financial concerns or uncomfortable side effects, and if not assisted, they will simply stop taking their medications. Each person’s mental and emotional state also come in to play, requiring different therapeutic techniques and strategies to achieve adherent behaviors.
For example, older homebound patients have unique challenges. Vidya Sharma, RD, CDE, worked with Barbara, an elderly woman with a fear of needles. Barbara was only getting her insulin when her attending nurse came twice a week. Vidya stepped Barbara through the injection process and had Barbara practice with her attending nurse, so that she could inject independently.
Nicole Anziani, MS, RD, CDN, CDE, HHC, CPT works with primarily Spanish-speaking patients. Anziani commented, “Because of the language barrier, I often find that it’s especially difficult for Latinos to navigate the confusing U.S. healthcare system and therefore they do not get the care that they should. I help them understand their diabetes care plan, so that they can have the confidence to manage their health on their own.”
Not only do patients have unique challenges and concerns, but they also require personalized solutions that are realistically achievable for them.
Sharma shared, “Some of my patients have similar questions, but their lifestyles are so different that they require different solutions. Let’s say we have five patients who all want to start exercising more. Kevin may want to exercise, but it’s not safe in his neighborhood, so we help find him a free local recreation center. Ronald is frustrated because there are no walking pavements in his neighborhood where everyone drives, so we send him to resources for exercises that don’t require a lot of space. Kara is homebound, so we send her exercise videos that she can do from her living room. Maria finds exercise boring, so her diabetes educator recommends dance classes. Doug wants to exercise, but he has chronic knee pain, so we recommend low impact exercises.” Although the different patients all want to exercise more, their unique situations require personalized solutions.
Personalization requires deeply understanding the patient and building trust.
Rebecca Brown, RN, CDE, shared, “Sometimes patients are not aware of their questions until we get on the phone with them and they start to open up. One patient was wondering why her blood sugars were through the roof when she was following her doctor’s instructions. We stepped through the process of injecting and discovered that she was never removing the inner needle cap, so she wasn’t actually getting any insulin!”
In order to solve the adherence problem, patients will need personalized support from expert clinicians who understand their needs and can address their specific pain points. With a tailored approach, clinicians can help prevent a patient from falling off their care plan, helping them to take control of their diabetes and improve their overall health.
With Fit4D, Certified Diabetes Educators (CDEs) can customize their conversations with each patient to address their individual needs. Not only does this help build trust and rapport with the patient, but also reinforces specific behaviors that will help the patient self-manage in the long term. Providing patients with one-on-one clinical support can be expensive. The Fit4D solution allows CDEs to scale the number of patients they can support to reduce costs.