Poor Engagement Takes High Toll on Diabetes Patients, Healthcare Costs

Statistics show that as many as one in five adults lacks the skills to actively engage in their own care. The healthcare industry must help individuals learn more about their health to better prepare them to participate in their own treatment.

That’s according to Mike Wolf, associate vice chair for research in the department of Medicine and Geriatrics at Northwestern University’s Feinberg School of Medicine. Additionally, healthcare should ease the complexity inherent in its operations that largely inhibits individuals from assuming a deeper role in addressing their medical needs, he says.

Poor Engagement Key Drivers

According to key findings on patient engagement published in an issue of Health Affairs, many patients lack health literacy-or a true understanding of their medical conditions. On top of that, the U.S. healthcare system often has seemed indifferent to patients’ desires and needs while many practitioners fail to provide the information that patients need to make the best decisions about their own care and treatment, according to the article.

“It can be difficult in our brief encounter system, but patients appreciate questions from their providers about what's difficult about the current treatment, what questions they have, and how satisfied they are with the way things are going,” says Jeffrey Gonzalez, PhD, associate professor of Medicine and Epidemiology & Population Health at Albert Einstein College of Medicine in New York.

Growing Priority

In a July 2016 online survey sent to the NEJM Catalyst Insights Council, which included U.S. healthcare executives, clinician leaders, and clinicians at organizations directly involved in healthcare delivery, more than 69% of respondents report that their organizations use patient engagement initiatives to increase patients’ meaningful participation in care

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Many survey respondents indicated the need to engage patients beyond the exam room with frequent, creative interactions that needn’t always include their physicians. Executives and clinical leaders said the chief medical officer is best equipped to lead such an initiative, while clinicians said staff physicians should do so.

Whatever the case, Wolf says that practitioners must take into account ordinary challenges individuals typically encounter. “After a doctor’s visit, patients may go home and enter their own world, which may distract focus from their diabetes or hypertension,” he says, which can water down their degree of engagement, leading to less than ideal self-management. “They may not achieve critical goals in managing or understanding their chronic condition, leading them to believe things like their medicine,” he says.

Money Matters

Then there’s the impact of patient engagement on cost. Patients with heart conditions, benign uterine conditions, benign prostatic hyperplasia, hip pain, knee pain, or back pain who received enhanced decision-making support by trained health coaches over the phone, by mail, and via the Internet ultimately had overall medical expenses 5.3% lower than those receiving only the usual support, according to a study published in Health Affairs They also had 12.5% fewer hospital admissions and 20.9% fewer preference-sensitive heart surgeries.

Gonzalez, who is also co-director of the New York Regional Center for Diabetes Translation Research at Albert Einstein College, says that ineffective patient engagement also can lead to individuals failing to do things like adhering to their prescription regimen. “I spend a lot of my research efforts on studying the problem of treatment nonadherence and am very familiar with overwhelming patient evidence that treatments often fail to help-or even cause harm-because they weren’t implemented the way they were intended to be.”

Prescriptions aren’t filled; medications aren’t correctly taken; lifestyle changes aren’t made, he continued. “This leads to unnecessary and significant costs for the healthcare system and patients.”

About half of patients with chronic diseases don’t take their medication as prescribed, according to the May 14, 2017 issue of NEJM Catalyst. Nonadherence also is associated with significant societal costs. Upward of $300 billion of avoidable healthcare costs have been attributed to medication nonadherence annually in the U.S., comprising up to 10% of total healthcare costs.

“When we encounter individuals less engaged in their care, it should tell us there are significant barriers to the patient's ability to engage in this plan, such as poverty, lack of sufficient understanding of the health threat to these goals, or competing demands on their time and effort,” Gonzalez says.

Chuck Green has covered healthcare for more than 10 years.