Dr Dhivya Ramasamy
Positive health outcomes depend not just on the clinical but also on the non-clinical aspects of a patient’s treatment plan
Aravind Eye Hospitals in Tamil Nadu has been grappling with this challenge for years and has striven to address this issue through active patient engagement. This article explores the potential of engaging patients in their treatment to achieve better treatment outcomes.
When can the treatment protocol be deemed to be effective?
How do we measure the effectiveness of a treatment plan? That’s a tricky question. At any healthcare establishment, the metric used is the number of patients seen or the number of surgeries performed. Let’s examine how this metric would apply to an eye care facility.
Similarly, children with uncorrected refractive error have a significant disadvantage and tend to do poorly in studies and sports. This can adversely affect the future career prospects of the child. While spectacles provide a simple and cost-effective solution, it has been reported that compliance with spectacle wear among school children remains as low as 30%.How do we ensure that the needs of children with refractive error are effectively addressed?
The inference from these examples is that for any treatment to be truly effective, it’s important that each and every patient successfully completes his treatment journey:
Figure 1: The Patient Journey
While we advocate this treatment pathway to all our patients, in reality we see patients drop off at different points along their journey, eventually rendering the treatment ineffective.
Over the years, we have experimented with the following strategies to reduce this drop-off rate:
Given that much of the treatment depends on the behaviour of the patient, our strategy has been to nudge him in the right direction. Actively engaging patients in their treatment plan can help in positively influencing their role in seeking care; adhering to the treatment advised; following instructions for self-care ; and returning for review visits.
Helping patients seek timely care
Awareness creation through well-designed health education programmes targeted at the appropriate audience can help patients identify symptoms and seek timely care. Squint or strabismus is considered to bring good luck, hence parents in India often do not attempt to correct these conditions. It is important to break such misconceptions. Parents should be made aware that strabismus can lead to severe visual impairment, so they must act fast.
Low birth weight children are at risk for Retinopathy of Prematurity, leading to degeneration of the retina. This can be controlled if managed within three weeks of birth. Thus it’s essential to make pregnant mothers aware of this condition so they can seek timely care for their premature babies.
Partnering with opinion leaders in the community
For conditions that are widespread in the population (such as cataract and diabetes), it’s important to rope in youth volunteer groups, NGOs, Rotary Clubs, etc to assist in information dissemination.
- Treatment effectiveness must be measured along the entire treatment pathway
- Patient barriers must be factored into your care delivery
- Hospitals must proactively engage with patients to create more awareness about their treatment choices
- Cultivating community partners can have a positive impact on treatment outcomes
- Counseling can be a powerful tool for patient engagement and enhances adherence
Helping patients make the right decision
At Aravind, counselors are an integral part of our clinical team. They ensure that patients have the opportunity to voice their concerns and clarify their doubts. Today, the cataract surgery acceptance rate is about 75% in our hospital, and about 85% in the outreach camps, thanks to the presence of these counselors.
Aravind’s counselors are recruited when they pass out from high school and are intensively trained for two years in : the basics of how the eye works; its diseases; treatment options; and counseling techniques. Regular monitoring and performance feedback help them perfect their counseling skills on an ongoing basis.
All said and done, patients have different information needs. Their concerns and questions are unique to the stage they find themselves in (Figure 2). Patient engagement strategies must be customized to address these specific needs and the individual’s treatment goals.
Figure 2: Information Needs of the Patient
(Source: The Informed Patient: Study Report, March 2003; D.E. Detmer, et al; Judge Institute of Management, UK)
In the final analysis, the hospital must take full ownership of patient disengagement and find innovative ways of engaging patients to help them reclaim control over their lost health.