Some Thoughts on Patient Education
Jody A. Charnow
I received a press release from the National Kidney Foundation (NKF) in late September announcing the findings of a survey it conducted with 450 dialysis patients and 75 caregivers.
The survey showed that nearly half of them indicated that their health care providers have less time to spend with them than in the past. In addition, 70% of patients and 80% of caregivers are “extremely interested” in learning more about how kidney disease affects patients' daily activities.
Physicians are indeed spending less face time with patients, according to studies and to what doctors have told me in conversation. Growing caseloads have forced them to shave minutes off patient encounters. Doctor-patient face time may get shorter still as a result of the federal government's new system of bundled payments for end-stage renal disease care. One consequence of this could be less time to educate patients about their illness.
Educating patients is a good thing, but does it make a difference in such important aspects of care as adherence to treatment? Studies have purported to show that patient participation in educational programs have led to improvements in phosphate control among hemodialysis (HD) patients and glycemic control in diabetics.
For example, at the NKF Spring Clinical Meetings earlier this year, researchers reported on an educational tool at DaVita called The 30-Day Phosphorus Challenge. More than 75% of dialysis patients who participated in the program said in a survey that they had learned something about phosphorus and more than 90% felt more confident about making lower phosphorus food choices after taking the challenge.
Other studies, however, have failed to find a benefit to patient education. For instance, a study of 85 African-American HD patients found that an educational intervention had no significant effect on medical adherence, according to a paper published in the Nephrology Nursing Journal (2011;38:155-162).
In a study published in the American Journal of Managed Care (2009;15:417-424), researchers found that educational interventions targeted at primary care physicians and patients did not significantly improve adherence to, and persistence with, osteoporosis drug treatment.
Regardless of what studies show, it seems to me, from my perspective as a patient (I am not a clinician), that improving adherence is at least partly a matter of tapping into patient psychology. People want to know why they are being asked to do something, and doctors' instructions frequently omit the “why.”
For example, doctors often prescribe antibiotics with the admonition to complete the course of treatment. I've never heard any doctor of mine mention that the reason for this is to ensure that the pathogen is eradicated and to prevent development of antibiotic-resistant bacteria, which would then be more difficult to treat.
For many patients, it can be language -- just that simple.