Abstract
The effective management of chronic illness has historically been plagued by patient non-adherence to treatment regimens. While disease management initiatives have recently proliferated in an attempt to more effectively manage these chronic illnesses, many of these new programmes have lacked effective behaviour change interventions. It is expected that this void will hopefully be corrected as more sophisticated second generation disease management programmes are developed.
This article explores the major issues and forces driving patient non-adherence and recommends a number of strategies to be used to enhance patient adherence and to improve patient self-management. Specifically, the authors propose 6 guiding principles for improving patient adherence and self-management. These principles include: (i) taking a comprehensive, holistic, patient-centred approach to disease management; (ii) being aware of the many different forms of nonadherence; (iii) facilitation of patient motivation and readiness to change; (iv) collaboratively supporting self-management behaviour; (v) focusing less on problems and more on solutions; and (vi) establishing and maintaining good communications with the patient.
The success of disease management will require, in many cases, a major reengineering of how we deliver and coordinate healthcare. Importantly, the development of systematic behaviour change interventions and adoption of a true patient-centred approach to disease management will be essential if meaningful, long term clinical and economic outcomes are to be achieved. Case managers and specialty disease management organisations that focus on the development of new, implementable behaviour change interventions will play a major role in insuring that our second generation of disease management programmes incorporate these new patient empowerment interventions.
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About the Authors: Warren Todd is Vice President of Business Development at Hastings Healthcare Group, a leading healthcare consulting firm. Mr Todd’s 20+ years of healthcare experience includes senior level marketing, strategic planning and business development positions for both for-profit and not-for-profit organisations. Prior to joining Hastings Healthcare he headed up the marketing, managed care and call centre functions at National Jewish Medical and Research Institute where he also engineered the organisations expansion into disease management and developed a number of major strategic alliances. Mr Todd is an internationally recognised authority in disease management.
In addition to his lecturing and contributions to numerous healthcare journals, Mr Todd is also co-editor of the recently published book ‘Disease Management: A Systems Approach to Improved Patient Outcomes’ and has 2 new books scheduled for release in 1998. He also is on the editorial board of 3 healthcare journals and a disease management newsletter.
Edward H. Ladon, Ph.D. is a Clinical and Consulting Psychologist, and a Principal in the Ladon Consulting Group. Prior to a recent move to Denver, Colorado, he was an Assistant Professor in Pediatrics at the University of Massachusetts Medical School, the Director of Consultation, Education & Training at the Worcester Youth Guidance Centre, and maintained a Private Practice providing Brief Psychotherapy and Behavioral Medicine services. He is currently working with the National Stroke Association on the development of telecommunications approaches to disease management for chronically ill patients, caregivers, and healthcare providers.
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Todd, W.E., Ladon, E.H. Disease Management. Dis-Manage-Health-Outcomes 3, 1–10 (1998). https://doi.org/10.2165/00115677-199803010-00001
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DOI: https://doi.org/10.2165/00115677-199803010-00001