Strategies for Medication Adherence

 One of the challenges for the healthcare industry is getting patients to adhere to their medication regiment. among the most common examples is that of antibiotics. Something that we learn in nursing school is that patients often will stop taking their antibiotic when they are feeling better, rather than taking the full course of the medication. Another example is getting patients to do prescribed exercises the improve body and system function, such as weight-bearing for bone and muscle strength or aerobic exercises for respiratory function.

The challenge, of course, is hat once the client has left the healthcare facility, it is up to them to comply on an ongoing basis by incorporating the new regiment into their old routine. I think we can all find examples in our lives where doing so, despite knowing the benefits, is challenging and results in failure.

What if healthcare organizations had a department for follow-up with clients on an ongoing basis to remind and ensure compliance? 

Think about a position for case workers, nurses, and therapists (PT, OT, RT, SLP, etc.) They can follow-up with the client via phone or video to ensure compliance. 

One challenge: who pays for it? Let's establish the chain of commerce: the client has health insurance and seeks care from the provider. The provider cares for the client and bills the insurance company. The insurance company takes premiums from the client pool and pays the provider. The provider gets a combination of payment from the client and the insurance company.

Let's think about this. The client is NOT going to want to pay every time that they get a phone call from the provider. That would almost certainly cause reduced compliance due to avoidance. It would be like a bill collector. 

Who in the chain has the most to gain, financially? The insurance company. Improved adherence should lead to a better health outcome fore the patient, which should result in lower ongoing costs, and then to reduced need for reimbursement from the insurance company. 

The insurance company has an incentive to give financial incentives to the healthcare organization for following up with the client to ensure adherence. If the client takes their pills everyday, exercises, etc. then there should be some specific, measurable long term goals that would be met. 

By achieving those metrics, the healthcare organization can finance the employees whose job is to follow up with clients and see how they're doing, including what friction or barriers they have to sticking with the program.

This provides a remote work position for teams or for people who are unable to work in person. This is an established position: I have a friend who works in oncology. She works 3 days per week, one of which is remote and responds to incoming messages through the client portal. Either in addition to that or as a separate position, people can use that position proactively to reach out to clients to see how they're doing by text, phone, or video. Examples of employees who may like this position include the rotation that my friend participates in, and someone who is on disability leave but could still do work, just not in person.

Finally, the healthcare organization could give the client financial incentives by showing adherence to the regiment. That could come in the form of direct payment (cash or gift card) or reduced billing. 

There may be some who feel that the hands-off, self-determination approach is best: if you want to get better, it's up to you. 

Others may think that the financial incentives lacks the altruism of helping people: people should be helped without needing financial incentives. 

However, the pragmatist knows that neither of those approaches is realistic. Companies expect to make money, workers expect to be paid, and clients expect service. By catering to improved outcomes from both the individual health as well as the financial perspectives, the interests of all parties are served. 

Quality Improvement in Healthcare: Typing Skills

 Documentation is one of the most important aspects of the healthcare system, yet many of the people in the system do not have adequate typing skills.

In any industry where documentation via keyboard is essential and expected, the company would be wise to implement keyboarding skills into their continuing education. (Including grammar and spelling wouldn't hurt, either.)

Am I an ex-homemaker already?

 As I get further into nursing school, one thing is for certain: the workload of school is increasing. While there may have been the same number of hours in classes in the first semester, the academic demands of the third semester (out of four total) are three to four times greater. No longer can I do an hour here, and hour there, and then a few hours on one day to keep up. It's two to four hours per day, every day. 

Which means that is two to four hours per day that I cannot take care of things around the house.

This thought popped when thinking about Thanksgiving. We have 8 people coming over, so having dinner for 12. I'm going to make turkey, stuffing (okay - dressing,) mashed potatoes, and mac 'n' cheese. I was also going to make pumpkin pie and gravy. All from scratch. Okay, I wouldn't make the the bread for the stuffing from scratch. But, I would chop everything, use gizzards for the gravy, and make chicken stock from chicken bones and mirepoix, make the pie crust from scratch, and make the filling from scratch (like, roast the pumpkin and sweet potatoes) and so on. 

However, in the next three weeks of school, I have a major project, several smaller projects, and a couple hundred pages to read (and comprehend and be able to make healthcare decisions based on.)

So now I get to make a choice: do homemade, or semi-homemade.

I think that the choice is simple, but it rips my heart out. 

I think we all have a craft that can be replaced by today's automation and prefabrication. I don't want to say that it's a shame, exactly - it enables people to use their time for the pursuits of their fancy. 

Of course, a whole discussion could be made about the choices that people make. For example, better to learn to cook, sew, or build, or to binge watch Netflix and scroll through social media?

So, as I make my list, I think I'm going to have to choose which thing I make from scratch. I'm pretty sure that I'll stick to turkey, that unforgiving protein that is so easily ruined (and so often,) mac 'n' cheese (which is primarily made by my younger child,) and mashed potatoes (because that's really easy and forgiving.) Stuffing: you're coming out of a box. Stock: box. Whipped cream: can. Gravy: can.

I recently heard someone say (I wish I could cite the source right now) that you don't know when it is that you'll do something for the last time. It could be getting picked up and held by your parent, picking up and holding your child, or seeing a friend. For a homemaker, there will be a last time that I walk a child to school. A last time that I yell at a child for failing to do a chore or for talking back. There will be a last time that I clean up a child's mess. A last time that the child walks through the door after school, home safe and with something new to tell me. There is a last time. 

Perhaps last year was the last time that I will have made everything from scratch. Will I miss it? I just don't know. 

Open letter to grocery stores

 Dear Grocery stores,

I have a suggestion for a change or addition you can make to help people shop and make good decisions.

First, let's talk about why people go to the grocery store: to buy food to prepare to eat.

Where do they get their ideas? Usually at home, but sometimes people go to the store and do the same thing they've done: wander around until they get inspiration (or resignation.)

On the other hand, we've seen an emergence of services like Hello Fresh, Blue Apron, etc who create meals and portion out ingredients that are delivered to your door.

However, many people like the social experience of going to the store. Here's how you, the grocery store, can profit by having a big brick-and-mortar store.

First, have meal ideas ready-to-go! You should have both print and QR options. You should have two different ways people can take advantage.

1) You have the meals prepped and ready for a person to pick up. It should also have a list of optional / essentials that people may / may not have in their kitchen (oils, salt/pepper, etc.) Have the aisle AND shelf location to find these things. How to make more money? Get sauce companies to sponsor their product, such as Tobasco, etc AND include the aisle and shelf! 

2) Help people put a meal together. An example: Salad! Seems simple, right? But many don't know how to use radiccio, chard, and other lettuces and just go for romaine / iceberg (which are fine.) So: educate them! 

Here's how it might look like:

Start with your produce: greens (lettuces), fruits (tomatoes, mangoes, avocado), chiles, peppers/cucumbers, roots. Have a sample of what a person might buy (1 head romaine, 1 cuke, etc.)

Then protein. Give them the choice of fresh, frozen, or pre-cooked.

And keep going. Tell the person where they can find the stuff EXACTLY and then what they may want to add to their order (dessert, chips, etc.) 

You also have prepared foods. Sell the thing you're advertising! In this way, your back-of-house prep team can make these meals to take away ready-to-eat OR ready-to-cook. Saves time and money.

Use what's cheap and in season! Increase your margin by creating menus that feature items that are both profitable and affordable. Everybody wins! Have date night options, family options, holiday options. Keep thinking! 

However, the current system of a big store is old thinking. Future-proof yourself by helping your customers get what they don't know they want. 

Thanks!

-DowntownDad