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