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Medication adherence in the safety net: Where simple innovations make big impact

Ray Pedden, Strategy Innovation Consultant Center for Care Innovations

Written by: Ray Pedden

They say, “Necessity is the mother of invention.” Nowhere is this truer than in the safety net where challenges are magnified by financial pressures, lack of resources and an unknown political landscape. The invention we see there is a far cry from the glamorous world of “think-tank” and “start-up” innovation. Instead, people have to come up with new and better ways of doing things just to get through the day.

The Center for Care Innovations (CCI) in California exists to help cultivate and empower this type of in-the-trenches innovation. While the community health centers and public hospitals that make up the safety net have to meet the same demands for high quality care as other types of providers, they have very little access to the resources that typically support innovation at academic medical centers and top-ranked integrated delivery networks.

These mission-focused organizations need to develop or leverage creative, low-cost innovations to better serve disadvantaged populations. As a result, safety net professionals learn that creativity does not necessarily require an elaborate, expensive expedition. For example, one CCI Innovation Hub has staff members simply write ideas down on sticky notes and place them on posters that were pinned to the wall in a back hallway. People jot down their ideas and others respond, saying why they thought the idea would or would not work.

Such an approach results in scrappy ideas that take on some of healthcare’s most pressing problems.

Consider a challenge such as medication adherence—a problem that, if solved, could save the healthcare industry between $100 and $300 billion in costs annually according to an article published in the Journal of Risk Management and Healthcare Policy.

Nowhere is this problem more acutely felt than in the country’s safety net facilities, where patient populations have low low-health literacy and may speak English as a second language or not at all, leaving them dependent on family and friends to help navigate a complicated healthcare system. These factors exacerbate an already trying challenge.

“We see a lot of indigent people, people who don’t speak English as their primary language, and those who may not be legal citizens,” said David Smith, PharmD, from San Francisco General Hospital. So it’s difficult to do a lot of consistent patient outreach once they leave the hospital, and it’s not easy trying to empower them to manage their own health. We have large numbers of Mandarin, Cantonese, and Spanish-speaking patients, and we also have Tagalog-speaking patients and a number of other populations. In general, it’s difficult for them to understand all their medications.”

The traditional approach to dealing with this challenge is to use human interpreters and rely on family members to assist the provider in painstakingly hand-transcribing simplified instructions into the patient’s native language. But what would happen if we could automate the process by which patients received simplified medication information to deliver it in their native language, at a literacy level they would be able to understand? Such an innovation, while simple, could make a world of difference.

We have had the opportunity to test out the impact of automating this process in pilot projects involving Meducation, a program developed by Polyglot Systems, now First Databank. Meducation offers ethnically appropriate drug information that can be understood by people at all reading comprehension levels. Here’s what the team piloting this solution at Zuckerberg San Francisco General Hospital learned:

  • Providers and staff improved the education process with patients, which resulted in a reduction in the amount of staff time devoted to medication adherence education.
  • Patients immediately recognized and appreciated receiving the information in plain language. Adherence improved.
  • For a cohort of high-risk inpatients, the readmission rate was reduced from 26% to 8%.

And, those are the type of results that everyone who works at safety net facilities truly values: Results that make a real difference in the care that is delivered to some very deserving patients.

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