Chronic diseases affect 133 million Americans and are often not managed effectively. For example, of 75 million individuals with hypertension in the US, one-third go untreated and more than half do not adequately control their blood pressure. A new study by UCLA researchers suggest that physicians take a serious look at tools and strategies used in behavioral economics and social psychology to help motivate their patients to assert better control over chronic diseases. They published their findings online in the Journal of General Internal Medicine.
The researcher note that one of the major health problems in the United States is the failure of patients with chronic diseases to take their medications and do all that is necessary to control their illnesses. They suggest that breaking large goals into smaller, more manageable parts, for example, may help patients better manage diseases such as diabetes. Diagnosing diseases and discovering effective treatments are not the only challenges facing healthcare professionals in the United States, noted lead author Braden Mogler, a third-year medical student at the David Geffen School of Medicine at UCLA and Charles R. Drew University of Medicine and Science. He explained, “One of the big challenges is simply finding ways to help the many patients with chronic diseases understand why treatment is important and how to follow it. Many doctors often lack effective tools to encourage patients in these ways. There is a lot of research from the social sciences on human behavior and encouraging individual change, and this paper shows how that research can potentially be applied to doctor–patient interactions.”
The researchers highlight the shortcomings of some approaches frequently used to help individuals control their diseases, such as scaring patients, overwhelming them with technical information, and focusing on consequences that are far in the future. They then identify several tools used by psychologists and behavioral economists that can change behavior but which have not been employed often in medical care, and suggest that research on such alternative approaches is an urgent need. These approaches include:
Helping patients form very specific plans to achieve their health goals. For example, identifying the time when they will take their medicines, having them determine what they will do if their prescriptions run out and they don’t have a doctor’s appointment, and giving them a place to record whether they took the medicines.
Breaking big goals into smaller tasks that get patients to their ultimate goal step-by-step — useful for goals like extreme weight loss, adhering to medication regimens and checking blood sugar every day, or exercising several times a week.
Using cash payments to patients as a motivator to get them on track but supplementing that with strategies that will increase their desire to stay healthy and live longer.
If studies show these techniques make a difference, they might improve health and decrease healthcare costs, noted co-author Dr. Martin Shapiro, chief of the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. He explained, “Helping patients get their chronic diseases under control sometimes requires changing medications but mostly comes down to helping patients understand why treatment is important and how they can follow it in their busy lives. There is a lot of exciting research on how we can help people change to achieve their goals in other fields, and we believe translating those ideas to healthcare is an important next step in medical research.”
The investigators found that some of these techniques are being used to a limited degree in health care settings. For example, helping patients quit smoking by settling on an exact quit date has proven more effective than speaking in general terms about quitting soon. They note that many other potentially effective techniques have not been studied in medical settings; thus, they stress the need for clinical trials to evaluate their effectiveness.
Take home message:
This study focuses on the physician’s role in urging patients to manage their chronic diseases. However, patients with a chronic disease or poor lifestyle choice such as smoking should become proactive in managing their health. In addition, if you know of a loved one who is not managing his or her disease properly attempt to help. Two recent products are available, which can significantly increase medication compliance. To learn more, click on this link.