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Associated Press
In this photo taken Thursday, Sept. 3, 2009, patient Linda Rankin, 60, of Selinsgrove, Pa., is prepared for hip replacement surgery at Geisinger Medical Center in Danville, Pa.
When you talk at the right level, health care outcomes improve.

SALT LAKE CITY — People go to doctors because they want to improve overall health, as well as deal with specific concerns. But to get the most out of treatment, patients and doctors have to be on the same page. Too often there's a disconnect between the two.

Experts agree that the American healthcare system's focus is shifting increasingly to one that is outcome-based, with emphasis on preventing illness, rather than just treating patients once they're sick. Success will require a shift in how patients and doctors approach each other.

According to a recently released report, "A Fragile Nation in Poor Health," nearly half of adults had one or more of six chronic illnesses: heart disease, arthritis, diabetes, asthma, cancer or chronic obstructive pulmonary disease.

Half of Americans don't believe their personal health is very good and almost a fourth say they struggle to be healthy. At the same time, 83 percent say they don't follow treatment plans their doctors recommend. Surveyed physicians put that number even higher, at 95 percent, says the report, which was produced by TeleVox Software, which creates patient-engagement communications tools.

Other researchers have noted the same thing. When Consumer Reports surveyed nearly 700 doctors recently, the No. 1 complaint was failure by patients to follow medical advice and treatment recommendations.

Reasons for the lack of follow-through cited by TeleVox include not knowing enough about the condition or medication, side effects, feeling better and therefore not believing the treatment is still needed, or not being able to afford it.

Several studies have shown that when a medication is prescribed to be used over the long term, only 15 percent are still on it at the end of the year, but when patients receive prompts to remind them, even every 90 days, compliance jumps to 85 percent, said Scott Zimmerman, TeleVox president.

Both patients and physicians face barriers and contribute to the challenges of improving treatment outcomes, Dr. Jeffrey Cain, president-elect of the American Academy of Family Physicians, told the Deseret News. "There are a lot of reasons that outcomes may be different from what the patient or physician think should happen," he said.

Patients may not understand the treatment plan, either because it was presented in a manner too complex for the individual to comprehend — a health literacy issue — or because the patient wasn't ready to understand. That happens sometimes when a patient is given a scary diagnosis, he said, like diabetes or cancer. And the healthcare system itself contributes to failure, with its emphasis on seeing patients quickly and efficiently, instead of focusing on interaction and understanding. Beyond that, some patients may not be able to afford recommended treatments or medications.

Another barrier — and a major concern patients cited in the TeleVox report — is what Cain (who was not involved with the report) calls the "old school thought" that care begins and ends in the doctor's office. Increasingly, he said, physicians are moving toward creating what's called a "patient-centered medical home" with better follow-up and reminders to help patients stay on track. People get cards in the mail when it's time for teeth cleaning or an oil change, he noted. Why not healthcare prompts?

The TeleVox survey found only one-fourth of healthcare providers believe it's their job to prompt patients to stay on track and follow treatment plans between visits. But most agreed patients would be more likely to comply if they were provided motivation and coaching.

"Traditionally, care is provided on a fee-for-service basis," said Cain. Doctors make their money when a patient comes into the office because he doesn't feel well. Patient-and practice-centered care rewards the provider for whatever practices best take care of the patient.

"Right now, the physician role typically stops where treatment begins," said Zimmerman. "Patients go it alone. You go in and find you have adult onset diabetes. A number of changes have to occur: You have to monitor blood sugar, take insulin or another medication, watch your diet... and you are receiving advice in probably a short span of time, then are expected to institute of number of behavior changes that would be difficult to any of us."

Good doctor-patient interaction is essential, he said.

To make it happen, Cain said, patients should talk to their doctor, bring in a list of questions, and ask about things they don't understand. The physician should provide the information a patient needs without overwhelming him or her and it should be done in language appropriate to that patient. The physician should also ask patients questions to be sure they understand. On some issues, it's also important to learn where the patient is in terms of being ready for change. When doctors first tell a patient he or she has cancer or diabetes, that individual typically isn't ready for change, Cain said. He describes five stages to healthcare change and compliance: Pre-contemplation, contemplation, initiation, action and relapse.

When the patient is ready, doctors can provide tools to help change effectively. And the language used really matters, he noted. There's a difference in understanding when you tell a patient to take a medicine three times a day (at breakfast, lunch and bedtime) or in recommending taking the medication every eight hours.

A study published in American Family Physician found that most patients read and understand at about an eighth-grade level. But 20 percent are at fifth-grade or lower. And they may mask the fact that they don't understand because they're embarrassed. Those with low health literacy levels, the study found, are more likely to be hospitalized than those with adequate health literacy. An estimated $69 billion in healthcare costs is incurred annually because of that illiteracy.

"When you talk at the right level, health care outcomes improve," Cain said.

The payoff for better communication and follow-up is huge for both parties in the doctor-patient collaboration. Patients become healthier and happier. And if that's not enough reason for doctors to improve their skills and reach out, he said, here's one that may resonate: It also reduces the number of lawsuits.

The report was based on a survey of 1,015 adults and 2,200 healthcare providers across various disciplines.

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