About a year ago, we discussed a problem that many, if not all, physicians and providers have probably encountered at some point in their practice: why won’t patients take their meds?
It’s a good read, but it’s since struck us that we maybe didn’t go far enough. After all, taking medication on a prescribed regimen is only the beginning of the directives a patient must follow.
For complex cases, long recoveries and extensive therapy situations where a patient’s entire lifestyle has to be rethought from the ground up, having your patients take a medication at a specific time per day may be the least of your concerns as a provider. You may have to ensure patients show up to appointments, undergo the appropriate rehab regimen, follow strict dietary guidelines, get the prescribed amount of exercise, track their own vital signs and more.
Health systems’ financial viability is increasingly tied to outcomes and the ability to prevent readmission in the 30-day window following discharge, so it’s more important than ever that providers do everything they can to ensure their patients follow physician orders. While an outright guarantee may never be possible, there are certainly ways to improve your odds of compliance and reduce the risk of readmission and unnecessary emergency room visits.
Remember the 'Instruct' Part of Discharge Instructions
As the Chief Clinical Officer at a healthcare IT company, I sometimes take for granted that hospitals are using the latest technology to communicate with patients. So imagine my shock when, on a recent outpatient experience with a family member, the nurse came in and stuffed a few pieces of stapled papers in with all the belongings. And those papers were their discharge instructions!
Granted, this was a pretty straightforward case and there wasn’t going to be much need for serious intervention, but I was still surprised to see discharge treated so perfunctorily.
It should go without saying that actually taking time, however long is necessary, to review discharge instructions is critical. As medical professionals, it’s easy to take for granted that what we consider to be the basics might seem pretty advanced to a patient still reeling from whatever incident brought them to the hospital in the first place.
Change Up Your Tech
Paper discharge instructions may be the standard at your facility, but as we start to treat more and more millennial patients, that reliance on paper is going to look outdated rather quickly. Many younger patients (as well as tech-savvy older patients) live out their entire lives on their phones and tablets, and it’s important to reach them on that level.
Discharge information will stand out more when presented on a tablet, especially if that information is interactive, requiring the patient to touch the screen to scroll through pages and see additional text.
Videos are another great way to get a patient to follow instructions more closely. So much of the content we consume on the internet is in the video format, and you may have patients that prefer to watch a quick tutorial than to read through rows and rows of text.
It ultimately depends on the preference of your patients, but having all options available and actually being able to ask them how they’d like to receive the info is a great way to make sure it sticks
Ask Your Patients to Tell You Their Discharge Instructions
This is an old teaching trick, but it’s one that will never go out of style.
Rather than just explaining the discharge instructions to patients and then asking them if they understand, follow up by asking them to explain to you what they’re supposed to do. Some providers worry they’ll appear condescending by doing this even with simple instructions, but I’ve found that patients really do appreciate the time and attention that’s being paid to them.
When they explain their comprehension of what you’ve told them, you can quickly identify areas of misunderstanding and get them corrected now, when it’s not going to impact their wellbeing later.
Have a Care Coordinator Check In…Often
Once your patient has actually left your sights, it’s important to have a member of the care team check in at regular intervals.
The timeframe of these intervals will necessarily vary depending on the complexity of their care plan, but it’s best to err on the side of caution. A check-in within 24 hours is always a good idea, and if given the choice between reaching out too soon versus too late, the former is always preferable.
Use Technology to Track Progress
Instead of just waiting to find out whether or not a patient is following the care plan and determining if an intervention is warranted, you want to be proactive. A care coordinator is one way to do this, but technology is another.
Today’s software solutions enable you to monitor a patient’s progress via wearable devices that track vital signs. They also provide intuitive apps and patient portals that enable the patient to access their information and input readings that matter to their care.
The great thing about using such technology is that, not only will you receive regular readings that could indicate a potential problem area, allowing you to intervene immediately, but you’re going to be alerted the moment your patient doesn’t comply with the care plan. Let’s say blood sugar doesn’t get put in the software for three days in a row; this can be the signal that tells a care coordinator to reach out.
This software is truly a boost for post-discharge compliance.
Get the Care Team, Patient and Family Members on the Same Page
It’s critical to get buy-in from everyone who might come into contact with the patient at any given time on their path to recovery.
If you’ve invested in remote patient monitoring software, then you’ll want to extend user invites to your preferred healthcare partners (post-acute care centers, in-home health services, rehab facilities, etc.). When everyone can see in real-time how the patient is progressing, it takes no time at all to coordinate potential interventions. You can message each other and the patient himself or herself right within the app.
It's important to bring patients and their family members in as well. Setting up the patient and their family within the system lets the necessary parties see the latest updates, change their habits based on your instructions, and ask questions directly to the designated provider. All of these things reduce the risk that the discharge plan will be circumvented.
Coordinate with Non-Healthcare Services
Finally, it’s not a bad idea to bring non-healthcare entities into the loop as well. So much recent research has focused on the social determinants of health and the outsized impact these factors can have on the wellbeing of a patient that it does a patient an injustice to not address these signifiers.
If your patient does not have easy access to transportation, for instance, you can reach out to a local taxi company or even Lyft to schedule pickups so that you know the patient will be able to make their appointments. Or, if access to nutritional needs is going to be an issue, you can work with an organization like Meals on Wheels.
Pay attention to the non-healthcare portions of discharge to ensure there are no impediments to following instructions.
With the number of tech solutions out there to address all manner of obstacles to wellbeing, you have an unprecedented ability to educate the patient, keep in touch with them following discharge and ensure their compliance with physician instructions.
It’s time to bring the number of patients ignoring or going against discharge instructions to zero. Follow the above tips to make it happen.