In 2019, we discussed the roles and responsibilities of patientsAmong the responsibilities: Accept the doctor’s expertise. Follow the doctor’s orders. And refill prescriptions as instructed. But, we know that many patients are resistant. Thus, the importance of motivating patients to follow medical advice.

 

From Twilio: Motivating Patients to Follow Medical Advice

Twilio is a communications firm, providing advice to clients. Recently, it published a research paper about “nudging” patients to better follow doctors’ instructions.

Next, some highlights of the paper:

No matter how effective a medication, protective a vaccine, or beneficial a lifestyle modification, clinicians must recommend them. Then, patients must engage with them to achieve improvements in health. Our decisions and behaviors are heavily influenced by the environment in which they occur. For example, small changes in how doctors present choices to patients, within the electronic health record (EHR) may lead to significant differences in the way clinicians order tests and treatments. Social networks and norms influence how individuals eat and exercise. In many cases, these influences go unnoticed. Or not given much thought. A concerted effort may help develop systematic approaches to designing interventions. Thereby, better aligning our decisions and behaviors with long-term goals.

True patient engagement requires observable performance metrics. Measured over time. In general, this remains still a concern. However, data being collected continue to demonstrate that patient engagement can be highly beneficial when performed in a coordinated manner. With the advent of devices to track activity, heart rate, and much more, the rise of AI to predict health issues from that flood of data, automation to “hover” over patients and so on, healthcare is on the cusp of putting patients where they belong — at the center of their own health (with some assistance).

The Nuffield Council of Bioethics created an intervention ladder. That helps to balance the impact of interventions with their ethical considerations. It can be adapted to form a nudge intervention ladder. As one moves up the ladder, nudges become both more paternalistic and more effective.

While tempting to jump directly to the top of the ladder. Remember that implementing those nudges requires access to more data from other systems. In addition to EHR data. Or, or in the context of clinicians, access to the EHR. Each of those are possible. However, the implementation and on-the-ground effort will be non-trivial.

The nudge ladder incorporates six steps. For information about them, look at the chart below the ladder.

Motivating Patients to Follow Medical Advice

 

Motivating Patients to Follow Medical Advice
 

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