Using Technology to Boost Patient Engagement with Care
Emerging, existing, and underutilized technology solutions to boost adherence.
Posted March 24, 2021 | Reviewed by Gary Drevitch
Co-authored with Charlotte Blease, Ph.D., Keane Scholar at OpenNotes, Beth Israel Deaconess Medical Center/Harvard Medical School
Remembering to take medications, stick with a therapy program, and follow a treatment plan can be hard for anyone. But we know that patients who are less likely to stick to their treatment plan face a greater risk of health complications, poorer outcomes, and even death. It’s an issue with a very big price tag: In the U.S., an estimated $300 billion annually in increased medical costs. However, new technological solutions may help keep people on track. Three of these approaches are important to keep in mind. One is likely new to you. One is something you may want to keep using. And one is something patients may already be trying today.
- Patients reading their clinical notes. With no extra effort and complying with new federal laws, it may be possible to help today. Like online banking, patients are being invited to log into health portals to access all of their clinical information online. From April 4, 2021, it will be a legal requirement that all patients in the U.S. (with few permitted exceptions) are offered online access to their clinical notes. Access is not just to lists of medications and referral appointments, but to the very words written by clinicians, including treatment plans. Research shows that this transparency has an unexpected beneficial effect on medication adherence. In a large-scale survey of nearly 20,000 patients taking or prescribed medications, 14% of patients who accessed their notes reported more adherence with taking their medications on schedule. The figure was even higher for patients diagnosed with mental illnesses such as major depression, bipolar disorders, or schizophrenia: 20% of these patients said they were more likely to take their meds as prescribed after reading their notes. Open notes strengthen communication and trust in clinicians, and this may help with adherence. After accessing their notes, patients report better understanding the rationale behind their drugs and possible side effects, and they describe feeling more in control of their care plan.3
- Telemedicine. While not as simple as simply sharing notes, telemedicine is quickly becoming the new normal for mental health visits. And these visits may be helping patients with adherence. Studies conducted prior to the pandemic show that telemedicine may improve adherence to meds, help reduce drop-out rates, reduce feelings of stigmatization, and increase patient satisfaction. In one controlled study of patients with mental illnesses, those given tablets set up for telemedicine were 20% less likely to drop out of care six months later.7 Perhaps because of convenience and accessibility, telemedicine helps patients stay on course. As it becomes possible to hopefully soon offer more in-person care, considering if telehealth has helped some of your patients with adherence is a useful consideration in shaping your practice.
- Apps. There are hundreds of medication tracking apps available today for immediate download. They can also help patients schedule healthy habits (e.g., exercise and sleep) and remember to attend appointments. The evidence suggests that an app alone will not dramatically boost adherence, but for the right person, it could be a useful solution. Sometimes an app is not even necessary: Helping patients use the calendar and alarm features native to their own smartphones can be a simple, free, and low-privacy-risk approach to offer a little extra digital support.
Sticking with treatment, therapy, and medications is a challenge for everyone. Technology is not a panacea, but sharing notes, telehealth, and apps may each offer some benefit to people and are worth keeping in mind as you optimize your practice going forward.
1 Semahegn A, Torpey K, Manu A, Assefa N, Tesfaye G, Ankomah A. Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis. Systematic reviews 2020; 9: 1–18.
2 Salmi L, Blease C, Hägglund M, Walker J, DesRoches CM. US policy requires immediate release of records to patients. British Medical Journal Publishing Group, 2021.
3 DesRoches CM, Bell SK, Dong Z, et al. Patients managing medications and reading their visit notes: a survey of OpenNotes participants. Annals of internal medicine 2019; 171: 69–71.
4 Walker J, Leveille S, Bell S, et al. OpenNotes After 7 Years: Patient Experiences With Ongoing Access to Their Clinicians’ Outpatient Visit Notes. Journal of medical Internet research 2019; 21: e13876.
5 Slightam C, Gregory AJ, Hu J, et al. Patient perceptions of video visits using veterans affairs telehealth tablets: survey study. Journal of medical Internet research 2020; 22: e15682.
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7 Fletcher TL, Hogan JB, Keegan F, et al. Recent advances in delivering mental health treatment via video to home. Current psychiatry reports 2018; 20: 1–9.
8 Jacobs JC, Blonigen DM, Kimerling R, et al. Increasing mental health care access, continuity, and efficiency for veterans through telehealth with video tablets. Psychiatric Services 2019; 70: 976–82.
9. Steinkamp JM, Goldblatt N, Borodovsky JT, LaVertu A, Kronish IM, Marsch LA, Schuman-Olivier Z. Technological interventions for medication adherence in adult mental health and substance use disorders: a systematic review. JMIR mental health. 2019;6(3):e12493.