Transcript Slide 1

Patient issues that get in
the way of TX adherence:
surprising survey findings
Sue Bergeson
Vice President Consumer Affairs
OptumHealth Behavioral Solutions

Who Am I?

The Art Work

The Context

It’s tough out there

Assume passion and
commitment

There is no blame

We are each expert in our own
arena
At the end of this
presentation, participants
will:
•Learn how to improve patient satisfaction, based on
the results of a large patient-based surveys
•Be able to enhance patient engagement; and
treatment adherence in their primary care behavioral
treatment;
•Learn how to optimize treatment results in a limitedvisit situation;
•Be familiar with the role and benefits of a peer
specialist
Communication Challenges

Face to Face Time: Seven Minutes

What would you like to see changed? N=3,662
Spend more time with me; don’t rush through
my appointment
PCP: second highest response
Psychiatrist: highest response
OBY/GYN: highest response

Time Before Interruption: ?

Time if Not Interrupted: ?
Strategy List
Allow the two minutes of patient conversation
before interrupting, I will leave not feeling rushed
and will have the chance to commit more fully to the
treatment regime
Experienced vs Communicated
78% Erratic sleep
77% Heighten mood,
75% Racing thoughts
74% Racing speech,
impulsiveness
72% Poor judgment,
67% Irritability
57% Reckless behavior
57% Erratic eating
56% Erratic sleep
36% Heighten mood
43% Racing thoughts
37% Racing speech,
Impulsiveness
35% Poor judgment
40% Irritability
26% Reckless behavior
26% Erratic eating
Stigma – Alive and Well
Internal
•
Patients were asked about their reactions when they were first diagnosed with depression. A minority
reported having negative feelings, including being afraid (33%), embarrassed (26%), angry (21%) or
stigmatized (20%). (DBSA Primary Care Survey 2000)
•
However, the vast majority of persons with depression report that when their condition was first diagnosed
as depression, they felt relieved to know what was wrong (59%) and glad their condition could be treated
(70%). (DBSA Primary Care Survey 2000)
•
Almost three-quarters (71 percent) of the respondents said that they would ask their doctor to prescribe
treatment. And few felt that they would lose their job (17 percent), lose friends (17 percent), or feel like
they have no one to talk to about it (14 percent). (NDMDA Gallop Pole Public Phone Survey (2002)
•
Just over one-fourth (26 percent) said they would neither worry about these things nor seek treatment. In
general, older adults, those with college experience are the least concerned about being stigmatized.
Those with the least education are the most concerned (NDMDA Gallop Pole Public Phone Survey (2002)
•
Most survey participants did not consider themselves knowledgeable about depression or bipolar disorder.
Thirty-six percent said they were very or somewhat knowledgeable about depression (NDMDA Gallop Pole
Public Phone Survey (2002)
•
50% most frequently associated depression with sadness (NDMDA Gallop Pole Public Phone Survey (2002)
•
While many did understand the need for medicine to treat mood disorders, nearly three-fourths (74
percent) believed that medications change the patient’s personality. In addition, over two-thirds (67
percent) believe the medications are habit-forming. (NDMDA Gallop Pole Public Phone Survey (2002)
•
Concern for a potential diagnosis of depression was much lower than concerns for other major diseases.
(NDMDA Gallop Pole Public Phone Survey (2002)
Strategy List
Allow the two minutes of patient conversation
before interrupting
Explain the illness and its importance and impact in
consumer words
 Address
our fear of medication upfront
Communication Challenges
 Explain your Illness to your satisfaction?
No: Psychiatrist 47%, PCP 63%
 Explain your treatment to your satisfaction?
No: Psychiatrist 48%, PCP 57%
 51 % Still wanted more information about their mental
illness
 Less than half of respondents had been given written
information
 81% who were given information - very useful
Strategy List
Allow the two minutes of patient conversation
before interrupting
Explain the illness and its importance and impact in
consumer words
Address our fear of medication upfront
Provide us with information we can read written in
consumer language
Stigma – Alive and Well
External
•
One-fourth believe that people with mood disorders are dangerous, can be
easily identified in the work place, and are not able to form and maintain longterm, stable relationships.
•
One out of five believe people with mood disorders should not have children..
•
One-fourth disagree that people with mood disorders live normal lives and
function well and work and at home.
•
All things being equal, about half (48 percent) of those surveyed would not vote
for a candidate for national office who had once been diagnosed with clinical
depression (24 percent would not vote for the candidate and 24 percent might
or might not vote for the candidate).
•
Nearly the same percentage (49 percent) agreed that people with mood
disorders are not stable enough to hold positions of authority.
•
In general, older adults, men and the less educated and minorities were more
likely to support the stigma associated with mood disorders
•
More females than males believe in the efficacy of medication as well as the
ability of people with mood disorders to lead normal lives.
Source: NDMDA Gallop Pole Public Phone Survey (2002)
Strategy List
Allow the two minutes of patient conversation
before interrupting
Explain the illness and its importance and impact in
consumer words
Address our fear of medication upfront
Provide us with information we can read written in
consumer language
Address the shame of mental illnesses directly in
conversation
Primary Care Survey
N= 2,000 – both consumers and providers
 PCPs
71% say they make joint
decisions, but
 Only 39% say doctor asked their
preferences
 PCPs
69% say they tell side effects,
but
 Patients, only 16% told
When you were prescribed
medication, what did your doctor
tell you to expect?
Strategy List
Allow the two minutes of patient conversation
before interrupting
Explain the illness and its importance and impact in
consumer words
Address our fear of medication upfront
Provide us with information we can read written in
consumer language
Address the shame of mental illnesses directly in
conversation
Explain what the meds will do and what I should
watch for
Relevance
 Recovery goals vs. Treatment goals
 Psych Nurse example
 Feel Bad  Take Meds  Feel Better
Feel Hopeless/Worthless  Change Life  Feel
Better
Five Stages in the Recovery Process
There are times when a person...
Impact of Diagnosis
Life is Limited
…has
given in
to
…is
overwhelmed
by
…the
Disabling Power
of a
Psychiatric Diagnosis
…is
moving beyond
Actions for Change
…is
questioning
…is
challenging
Commitment to Change
Change is Possible
Five Stages in the Recovery Process
Impact
of
Illness
Life
is
Limited
Change
is
Possible
Commitment
to
Change
Actions
for
Change
The person is
overwhelmed
and confused
by the
disabling
power of the
illness.
The task is to
decrease the
emotional
distress by
reducing the
symptoms.
The person has
given into the
disabling power of
the illness and is
not ready/able to
make a change.
The task is to
instill hope, a
sense of
possibility, and to
rebuild a positive
self-image.
The person is
beginning to
question the
disabling power of
the illness and
believes that his/her
life can be different.
The task is to
empower the person
to participate in
his/her recovery by
beginning to take
small steps.
The person is
challenging the
disabling power of
the illness and is
willing to explore
what it will take to
make some
changes.
The task is to help
the person identify
his/her strengths
and needs in terms
of skills, resources
and supports.
The person is
moving beyond the
disabling power of
the illness and is
willing to take
responsibility for
his/her actions.
The task is to help
the person use
his/her strengths and
to get the necessary
skills, resources and
supports.
Strategy List
Allow the two minutes of patient conversation before
interrupting, I will leave not feeling rushed and will have the
chance to commit more fully to the treatment regime
Explain the illness and its importance and impact in consumer
words
Address our fear of medication upfront
Provide us with information we can read written in consumer
language
Address the shame of mental illnesses directly in
conversation
Explain what the meds will do and what I should watch for
Link my treatment to my recovery goals/what I care about
Consumer Perceptions: What We Really Want
consumer
family member
To be treated with respect
Doctor nurse or therapist who
listens to my family member (tie)
Thorough explanations of what is
going on
Doctor nurse or therapist who
listens to me
2
Treatment that looks at my family
member's whole life not just
medication
Treatment that looks at my whole
life not just medication
3
Treatment that builds on my family
member's strengths instead of just
focusing on the illness (tie) Care
that provides hope
Thorough explanations of what is
going on
Options other than hospitals when
my family member feels bad
1
4
Treatment that builds on my
strengths instead of just focusing
on the illness (tie) Care that
provides hope
5
DBSA Survey 2004 N=2,000
Easier access to the medications my
family member's doctor prescribed
(insurance won’t pay or wants my
family member to take something
else first or I can’t afford the
medication)
Link consumer to peer resources

John Rush, MD, DBSA support group participation fewer
hospitalizations, greater adherence

Mark S. Salzer, Ph.D., mental health self-help groups are
associated with decreased symptoms, increased coping
skills, increased life satisfaction, and greater adherence
Peer Specislits as a Resource
Certified Peer Specialists aka Recovery Coaches in
Primary Care Settings
 Surgeon General – power of peer support
 President’s New
 Freedom Commission 2.2
Role of peers in service delivery
 Institute of Medicine Report Increasing
role of peers in recovery
 Annapolis Coalition Report on the
Behavioral Health Workforce Goal One
 CMS Acknowledgement as EBP
Certified Peer Specialists / Recovery
Coaches Roles in Primary Care:
 Time: Warm Hand Off (Heart)
 Psychosocial Education: Druss/Lorig, Living
Successfully (Baby)
 Stigma Reduction (Corrigan)
 Adherence/engagement: WRAP, Support
groups, community engagement, Mood
charting, follow up
 Whole health, smoking cessation groups,
soft exercise, diet, stress management
 Post Hospitalization Bridge

Hope
Certified Peer Specialists / Recovery
Coaches
 Georgia Research:
Overall, peer support consumers showed
improvement as compared to control group
in each three outcomes over an average of
260 days between assessments
 Current symptoms/behaviors
Skills/Abilities
Resources/Needs
Strategy List
Allow the two minutes of patient conversation before
interrupting, I will leave not feeling rushed and will have the
chance to commit more fully to the treatment regime
Explain the illness and its importance and impact in consumer
words
Address our fear of medication upfront
Provide us with information we can read written in consumer
language
Address the shame of mental illnesses directly in
conversation
Explain what the meds will do and what I should watch for
Link my treatment to my recovery goals/what I care about
Encourage participation in free peer support groups
Consider hiring a CPS for your practice
DBSA /NAMI Survey:
What we want from
our providers:
1. Listen
2. Communicate
3. Compassion (tied)
3. Knowledge (tied)
4. Interpersonal Skills
5. Attitude of Respect
6. Skill
7. Allow enough time
8. Work in partnership
with us
9. Don’t just medicate
10. Look at the whole
person
DBSA Survey 2004 N=2,000
I want the health care
system to:
1. Give me hope/seem
hopeful about my future
2. Let me make decisions /
have some input into my
treatment & care
3. Focus on my wellness not
my illness
4. Act in a way that shows
they believe that I can
recover
5. Listen to what I need
instead of telling me what
I need
Thank You
Sue Bergeson
Vice President
Consumer Affairs,
OptumHealth
Behavioral Solutions
Susan_R_Bergeson
@uhc.com