Many of the advances in modern medicine can be attributed to improvements in diagnosing physical conditions with lab test (Hemoglobin A1C levels), medical imaging (lesions, fractures) and electrocardiogram (arrhythmias). We can now identify the DNA of each of the hundreds of different bacteria present in our microbiome. Moore’s law continues to reduce the cost of computing, which will make sequencing our genomes affordable as well as measuring the current expressions of our proteomes and metabolomes. These amazing diagnostic advances will not only advance personalized medicine, they will measure treatment performance daily or hourly via the expressions of our proteomes, metabolomes or circulating DNA fragments of cancer cells.
While aging, genetics and environmental determinants contribute to cancer, diabetes, hypertension and COPD, so does human behavior. For many acute chronic conditions, the source can be attributed to the patient’s behavior as well as their associated social, socioeconomic and environmental determinants. The science of diagnosing human behavior may prove to be as difficult as identifying the source of physical abnormalities. Yet, identifying the patient barrier preventing the desired human behavior may be a worthy and achievable goal.
Patient Barrier – a contributing factor of patient behavior that may negatively impact patient outcomes if not addressed. Patient barriers can be addressed with interventions to improve outcomes. Examples of patient barriers include lack of access to a primary care physician or after hours care, health literacy, money for food, housing, medicine or a home, lack of a care giver, friend or transportation.
If the patient says they will not take their medicine because they can’t afford it, we may never scientifically conclude that limited financial resources is a patient barrier. Yet if we begin to document patient barriers the same way we document diagnosis codes (ICD Codes), we may understand the impact patient barriers have on patient outcomes. For the 5% of patients that account for 50% of healthcare spending, it could improve their lives and save billions of dollars.
When we document patient barriers and the associated interventions (including E Interventions) that address them, we will learn what works. We may get further insight into:
- Why one third of Americans are obese?
- Why people are inactive?
- Why people are not eating enough fresh fruit, vegetables and legumes?
- Why people with hypertension, hyperlipidemia or diabetes do not take their medicine?
- Why people on 5 or more medicines do not seek help when they leave the emergency room with 3 new prescriptions?
- Why people experiencing acute conditions avoid seeing a doctor until they have to call 9-1-1?
- Why people with diabetes do not show up for their endocrinologist appointments?
- Why people do not take care of themselves when they know how?
- Why people continue to abuse alcohol, drugs or engage in risky sexual activity?
- Why people are lonely or stay in abusive relationships?
- Why people are depressed, anxious, or stressed?
We can’t expect a medicine or treatment to be effective without changing the human behavior that caused the acute or chronic condition.
It is reasonable for people to say that patient barriers could be abused by patients as excuses. The barrier could be used by the patient to justify (or feel good about) their behavior (not taking their medications). Patients may be able to get something from a healthcare provider that is being held accountable (via value-based payment models) for their overall medical cost. Patients may make up a patient barrier to help them get a ride to the physician office rather than bothering a family member.
Yet, the definition of a patient barrier is that it’s a contributing factor of patient behavior that may negatively impact patient outcomes if not addressed. Just like prescribing a statin requires a diagnosis (high cholesterol), the patient barrier diagnosis has to accurate. It must conclude that the physician visit is critical to the patient’s outcome and they have a history of missing appointments based on a barrier (no caregiver).
There is so much written about the United States healthcare system transition from fee-for-service to value-based payment models. For healthcare providers, success has been tied to diagnosing and treating conditions. To thrive in these new payment models, success will also include diagnosing and addressing human behavior.