The patient-physician relationship is paradoxical. Most patients understand the expertise of their physicians but fail to follow instructions or withhold important information that would improve their medical status. About 70% of patients have withheld relevant information from their doctors for fear of judgment. Perhaps even more problematic, medication adherence issues have caused 125,000 deaths and 10% of all hospitalizations, while costing the United States between $100 billion and $289 billion annually.

Beyond existing issues with patient adherence and openness, the growing focus on home care could complicate the picture further. The push to bring patients home earlier is positive. It will free up physicians to focus on critically ill patients, reduce the burden on hospitals, and save money. But it also creates distance between patients and physicians, creating additional adherence and engagement challenges.

To address these problems, the medical industry has begun to search for new ways to engage patients. Largely, its efforts have focused on physicians, but ideally the scope of engagement should be much wider, including device and drug manufacturers as well.

THE CHALLENGE OF ADHERENCE
Patients fail to adhere to doctors’ orders or share important information for several reasons. These can be educational (confusion as to how, when, or why to take medicine), financial (fearing an increase in insurance costs or not wanting to pay for treatment), psychological (fear of physician judgment or treatment or not being convinced that treatment is necessary), or physiological (trying to avoid the adverse effects of a treatment). To address these issues, the medical community has developed several engagement approaches that range from contacting patients by telephone to using sensors to confirm that they have taken their medicine. Applications are also being developed to remind patients of their medication schedules.

These engagement approaches are good but often treat the patient as an obstacle rather than a partner. Engagement should be a means to an end, with the goal of activating patients to care for themselves, which is proved to have a significant effect on medication adherence. To do so, physicians must give patients the confidence and tools to care for themselves, which is made harder by unnecessarily complicated medical tools with which patients must interact.

ENGAGEMENT BY DESIGN: INFUSION
Home infusion is a good example of how devices can play an important role in adherence and patient activation. Home infusion is overseen by patients themselves, sometimes with the help of home care nurses. Unfortunately, infusion therapies can be complicated for patients to adhere to. Infusion involves loading the drug, choosing the right settings for the specific device, ensuring the sterility of both device and drug, and recording dosage amounts and time so that doctors can help adjust the treatment from afar. Any one of these could create opportunities for mistakes or for a patient finding reasons to quit.

The devices that are crucial to the entire process are often designed for trained medical professionals. They look intimidating and have many settings that are irrelevant for patients.

Medical device designers should instead strive for the same communication with patients that we ask for from physicians. The message that customers should get from standard medical devices or drugs is that, accompanied by advice from a medical professional, they can competently and safely use the product.

This can be achieved through design. Devices should be as intuitive and unobtrusive as possible to prevent patients from turning off alarms or stopping treatment altogether. We can emphasize connectivity to make it easy for them to track their progress on computers or smartphones. And we can push for customization of devices to disease conditions to design them with the particular needs of the patients in mind. 

If patient activation was a primary goal for everyone who works in the health care industry, it would create new opportunities for patients to take a significant role in their care, and increase satisfaction, while reducing costs and workloads. It could also create a stronger partnership between patients and physicians, leading to a greater level of comfort and openness between patients and physicians and even more importantly, higher levels of treatment adherence to support better patient outcomes.
 
Shaul Eitan is CEO of Avoset Health in Netanya, Israel, an Eitan Group company.