Featured Articles                                                   May 2010, Vol. II, No. 13
Education, Intervention Needed for Medication Adherence

According to a new study conducted by CVS Caremark and Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ), because the issue of medication nonadherence is larger than previously thought, there is an increasing need for additional education efforts and intervention programs to improve the likelihood of patients adhering to the protocols prescribed by their doctor.

The study looked at e-prescriptions written by 507 doctors in the Horizon BCBSNJ network between January 2006 and October 31, 2006. The intent of the study was to determine the extent and cause of primary nonadherence for people prescribed medications for high cholesterol and asthma. The study reviewed only e-prescriptions written for the two chronic illnesses, which gives a clearer indication of those not filling their initial prescription because electronic orders reach drug stores immediately and claims data shows which prescriptions are picked up — or not. The study found that more than 20 percent of patients who were prescribed asthma controllers and over 34 percent of patients who were prescribed medications for high cholesterol did not fill their initial prescriptions.

Non-adherence to essential chronic medications has been widely recognized as a major public health problem in studies published in medical journals. Past studies show one-quarter of people receiving prescriptions never fill their first prescription, and patients with chronic diseases such as diabetes and coronary artery disease adhere to their ongoing medication regimen about half of the time. Non-adherence to essential medications is a frequent cause of preventable hospitalizations and patient illness, with costs to the U.S. healthcare system estimated at about $300 billion annually.

Get more information here.

Quotable: Integrating a Health Improvement Program

"Employers and employees all want the same thing — they want something called integrated health management. It will probably be called something different by every health plan and every vendor in the country, but it comes down to a strategy for improving health that is sustainable for the long-term. Itís a program for health improvement that reaches every person, not just seven-tenths of 1 percent of the population who are morbidly sick. It focuses on keeping the healthy people healthy and incorporates incentives because we know free is not enough. If you really want to get a good return and get engagement and participation, itís going to take some carrots. There has to be measurable goals. It has to be data-driven and go way beyond ROI."
                                        — Roger Reed, Gordian Health Solutions.

Learn more about integrated health coaching.

Telephone Counseling Improves Fruit, Vegetable Consumption

Combining telephone counseling calls with a daily written diet plan increases a person's success in improving fruit and vegetables consumption, according to a study published in Preventive Medicine. Nutrition often gets neglected in preventive healthcare for many reasons, including lack of time, lack of training and economic restraints, says researchers. However, a simple thing doctors can do to help patients eat better is to have them write down what they eat each day to identify which changes need to be made.

Researchers evaluated subjects based on one goal: to increase fruit and vegetable consumption by at least two servings a day by replacing one less nutritious item. The subjects — who were age 40 or older, in general health and consuming less than 5.5 servings of fruit and vegetables a day — were randomized into three groups. Group one received only educational materials containing information on dietary recommendations, suggestions and lists of healthy foods. Group two received the educational materials as well as a form to create a specific daily food plan based on their current habits. Group three received the same materials as group two, including three counseling calls from a registered dietician and a small log book that included check boxes to monitor fruit, vegetables and less nutritious foods. The counseling calls consisted of reviewing the written plan, reviewing the self-monitoring logs and discussing any progress made towards the goal.

At the end of 12 weeks, all of the subjects were assessed through unannounced telephone calls from a registered dietician asking them to recall everything they had consumed in the past 24 hours. Subjects in group three increased their fruit and vegetable intake significantly compared to those in groups one and two. According to the researchers, ďPeople need more support than educational materials. Everyone knows what healthy foods are, but itís hard to make the changes needed to break old habits, such as the familiar grocery shopping routine. Sometimes itís difficult to find accountability within yourself to make changes, but if someone is checking up on you, youíre more motivated to do the right thing.Ē

Read the full article here.

Achieving Medication, Care Plan Adherence Through an Integrated Care Team
While neither colocation of team members nor an electronic health record is a prerequisite for a successful integrated care team, explains Dr. Jan Berger, chief medical officer of Silverlink Communications Inc., there are four essential factors that contribute to the confidence and comfort levels of both patients and team members.

Listen to the podcast here.

New Chart: Healthcare Case Manager Work Locations

Case managers' influence has expanded beyond the health plan office to primary care offices, hospital halls, nursing homes, skilled nursing facilities, and alongside the patient at a provider or home health visit. We wanted to see how many healthcare organizations are embedding case managers at care sites and which care sites merit the most case manager effort.

Click here to view the chart.

Coaches Who Produce the Best Results

Question: What traits or characteristics separate the good coaches from the great coaches — the ones who produce the best results?

Response: Certainly the motivational interviewing literature has shown that establishing empathy at the first clinical encounter demonstrates improved outcomes. The capacity for empathy is a pivotal foundation, but itís not efficient. Abraham Maslow said, ďWhatís necessary to change a person is to change their self-awareness.Ē That applies to the coach as much as it does to the patient — that is, the coach having increased self-awareness of how theyíre working in the moment with working with patients over time. To give a slightly different perspective, itís not a question of taking people from good to great, but from fair to good as well. One of the challenges in the healthcare field — which an individual could encounter when they open a lifestyle clinic in a primary care setting — is that most healthcare practitioners have been schooled in the fix-it role and not in a motivational role. That role shift is very significant, and in the fix-it role, a practitioner tends to assume responsibility for the outcomes. In the motivational role, a practitioner is an agent of influence, but they donít control the outcome. Great coaches are able to increase their capacity for positive influence in others over time.

(Dr. Richard Botelho, professor of family medicine at the University of Rochester Medical Center.)

Learn more about health coaching results.

HCH Readers Save 10% on Coaching Resource

Health Coach Hiring, Training and ROI: Profiting from Behavior Change is a 45-page special report that provides a blueprint for staffing and supporting a successful health coaching program as well as measuring and maximizing the behavioral, health and financial outcomes that result. This report includes strategies for the screening, hiring, training, mentoring, certification and continued educational support of health coaches, as well as metrics for evaluating the success of an online, telephonic or in-person coaching effort and maximizing program ROI.

HealthCoach Huddle subscribers should use ordering code HCH to purchase this product at a special price!

Get more information on health coach hiring, training and ROI.

Telephone Connectivity Supports Medical Home Model, Removes Barriers to Care

This white paper articulates the value of telehealth — namely the utilization of the telephone to provide physician or consumer-directed cross coverage 24/7 — as an emerging and effective application in tackling specific issues related to episodic care as well as chronic care management for diseases such as diabetes, cancer and cardiac disease.

Download complimentary white paper here.

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