Understanding patient attitudes and preferences within the context of the patient journey can be central to supporting healthy behaviors and better health outcomes. To improve treatment adherence, health systems and clinicians should know their patient populations beyond demographic and disease information. They should consider getting to know what drives patient decision-making.
Patients are more than their disease—they are people with families and jobs, financial concerns, time constraints, desire for social support, and myriad other needs. They have different cultural backgrounds, beliefs, and life experiences. They also respond differently to health concerns.
Consider Jennifer and Michael. Both have type 2 diabetes. They are overweight, tend to make poor food choices, and have sedentary lifestyles. Their blood-glucose levels are poorly controlled and they are at high risk for developing cardiovascular and other complications of the disease. Both patients received a prescription for metformin, but neither one of them is highly adherent to the medication or to the lifestyle changes recommended by their doctor. While they have many things in common, it could be a mistake to assume the same factors drive their lack of adherence or to use the same strategy to promote behavior change.
Michael and Jennifer are personas that we created based on data from the 2016 Deloitte Center for Health Solutions Health Care Consumer Survey. The survey is nationally representative and asks questions about a large number of health related experiences and attitudes, including non-compliance with treatment plans among chronically ill patients. We analyzed patient preferences about clinicians (e.g., specialty, gender), care setting (e.g., office-based, outpatient, inpatient, in home, mobile, telehealth) and technology (e.g., use of internet for scheduling, communications, diagnosis, care delivery, home monitoring). We identified some preferences that were shared by the majority of respondents, such as wanting clinicians who take time to listen and who can explain treatment options. But patients had different preferences when it came to communication channels, use of technology, time availability, and amount of information they wanted.
Chronic diseases account for seven out of 10 deaths in the U.S. every year and 86 percent of our nation’s health care costs.1 Many of the most prevalent and expensive chronic diseases, including heart disease, stroke, and type 2 diabetes, are largely preventable. Further, health spending makes up about 17 percent of the Gross Domestic Product and is projected to grow at an average rate of 5.6 percent per year for the next decade.2
To help effectively change behavior, health care organizations should understand the factors that can influence a patient’s willingness to comply with a prescribed treatment. Based on a patient’s personality and preferences, clinicians could be able to anticipate the patient’s willingness to engage in a treatment.
Could a retail marketing approach be effective?
Defining customer personas based on purchasing behaviors and preferences can help retailers tailor marketing strategies for different types of customers. For example, tracking buying habits can help retailers match specific products to potential customers who are most likely to be interested in those products. Understanding customer preferences for live customer-service contact for customers who are tech-savvy underscores the importance of an educated staff, whether online or in a store. By taking a customer-centric view, retailers can identify and anticipate needs and create products or services to fill those gaps.
Health system leaders are beginning to realize that they hold tremendous amounts of data that could be used to more effectively target patient populations. However, traditional approaches to population analytics involve segmenting patients into age, geographic location, and other demographic or disease categories. These characteristics are important in describing what happened (e.g., 25 percent of chronically ill patients do not adhere to treatment plans) but offer little insight into patient behavior.
Knowing what motivates patients could lead to customized treatment plans
What drives patients to make decisions and take action? To answer this question, health care organizations should understand patient preferences, motivations, and attitudes. Drawing on methods from the retail sector, health care organizations can learn to anticipate how a patient might respond to a treatment plan based on certain behavioral, demographic, and disease characteristics. Such insight could then be used to modify the treatment plan to better suit the patient.
This multidimensional approach can increase a patient’s adherence to prescribed medication or post-discharge exercise routines and thereby help reduce costly readmissions, decrease utilization, and improve outcomes. A 2008 cross-sectional study showed that patient intent to adhere, trust, and to be satisfied with care all increased when the physician used patient-centric communication tactics that considered the patient’s age, education, and culture/language.3 By incorporating the patient’s perspective, physicians improved the patient’s willingness to adhere to the prescribed treatment plan.
Remember Jennifer and Michael? It is difficult to know exactly why they don’t comply with the recommended medication, lifestyle changes, and self-management plan. Creating personas to represent various patient characteristics might help clinicians learn to communicate more effectively with actual patients. It could help clinicians offer interventions and disease-management strategies that align with patient preferences and help break down adherence barriers.
Here is an example of how understanding a patient’s persona could help clinicians improve the patient’s adherence to a treatment:
- Michael is knowledgeable, tech-savvy, and busy. He thinks that seeking care is inconvenient or too time consuming. As a busy, self-reliant patient, he might not feel fully engaged in the treatment plan or might not see the value of therapy. His targeted intervention could include text reminders to take medication and complete blood-sugar tests. More than half of those who participated in Deloitte’s consumer survey4 expressed an interest in using technology that could remind them to take medication. Access to appointments outside of typical work hours (whether virtual or in-person), shared decision-making, transparent cost and quality information, and access to virtual alternatives and technologies for self-care could help improve Michael’s health outcomes.
- Jennifer has an aversion to technology. She thinks it is difficult to get an appointment, and considers her treatment plan to be too expensive. Her tailored treatment plan might include in-person conversations with a nurse or diabetes educator, home visits from a community health worker, weekly meal plans, and support from family members and friends. This could help her to understand the importance of taking her medication daily and could provide the encouragement she needs to increase her physical activity and improve her diet.
Additional ethnographic research could help create a comprehensive understanding of each persona, including hopes and fears that drive patient behavior. Some clinicians already incorporate patient personas into the design and execution of patient-centered services. Supporting the right patient experience by design can help improve patient health and help the health systems and health plans gain a competitive edge in the market.
How do patients experience their care?
Exploring patient preferences and beliefs through the development of patient personas is one important step in improving adherence to therapy. Understanding the patient journey, or a patient’s experience during care, is another. Mapping the steps in a patient journey can help to illuminate where patients might experience barriers or other influences that can cause non-adherence.
Consider the steps a diabetic patient goes through from diagnosis to management:
- Symptoms prompt the patient to make a doctor appointment.
- An examination and tests confirm diabetes.
- The patient begins to learn about the condition.
- The doctor discusses diabetes management with the patient
- The patient is referred to a nurse or diabetes educator for additional information and training in self-management—especially if insulin and blood-glucose testing are required.
It is up to the patient to pick up medications, remember to take them (and blood test if needed) according to the schedule. The patient must decide how to adjust diet, determine what to buy at the grocery store, learn new ways to cook, and find a time and place to exercise. Once these general steps are identified, targeted questions from the clinician can uncover what influences decision-making at each step.
Patient preferences can be turned into influential actions
Health care organizations should consider investing in the interventions that are most likely to improve health outcomes and the bottom line. Developing a comprehensive understanding of patient behaviors can lead to new solutions. Interventions previously seen as unsuitable for certain patient populations based on age, could be reconsidered using patient-preference data.
Case in point: A 2015 review of non-invasive telemonitoring for heart-failure patients determined that remote monitoring and support reduced all-cause mortality and heart-related hospitalizations. Despite an initial expectation that elderly patients might be unable or unwilling to learn and use the technology, this group was just as satisfied with their outcomes as younger patient groups (as long as they received at least an hour of one-on-one training with the new technology).4 This research helps illustrate the value of developing personas based on multiple characteristics and preferences, rather than relying on demographics alone.
Health systems should consider factors that matter to the patient, such as engagement, convenience, and experience of care. Growing evidence shows that a focus on engagement and experience can improve the bottom line in a hospital setting, and can increase safety and quality overall, according to Deloitte research on the value of the value of patient experience. Persona segmentation can help clinicians alter patient behavior by improving patient experience and engagement. Improving treatment adherence can help reduce avoidable care and costs.
1 Centers for Disease Control and Prevention (CDC). Chronic Disease Prevention and Health Promotion. Retrieved from https://www.cdc.gov/chronicdisease
2 Centers for Medicare & Medicaid Services (CMS). National Health Expenditure Fact Sheet. Retrieved from https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html
3 Street et al. (2008). Understanding concordance in patient-physician relationships: personal and ethic dimensions of shared identity. Annals of Family Medicine, 6(3): 198-205.
4 Cimperman et al. (2013). Older Adults’ Perceptions of Home Telehealth Services. Telemedicine Journal and E-Health, 19(10): 786-790.