7 communication strategies to address gaps in care


Gaps in care cost patient lives and health systems close to 500 billion dollars a year.

A gap in care is the discrepancy between recommended best practices and the care that is actually provided — essentially, when patients don’t get the care they need.

For example, poor treatment adherence is a well-established gap in care. And medication non-adherence accounts for approximately 125,000 deaths in the U.S. per year.

Innovative verbal and digital communication practices can help health systems bridge this and other gaps in care.

1. Frame risk communications

The information patients receive about their health impacts the decisions they make — such as whether to take their medication as prescribed or attend a routine screening. Hence, deliberate communication around risk can help reduce gaps in care.

Dr. John Paling, founder of The Risk Communication Institute, suggests the following approaches for framing risk communications:

  • Statistics are better than vague terms. Instead of telling a patient they are at a “high risk for liver disease,” say, “Roughly half of men who drink more than 8 ounces of alcohol a day for 20 years develop cirrhosis.”
  • Present data with visual aides. Sometimes it’s easier for a patient to visualize their risk of developing a condition if they see a line graph showing a steady risk increase associated with their behavior.
  • Be consistent when comparing. For example, don’t mix fractions and percentages, and use absolute numbers.
  • Give both sides of a statistic, such as chances of survival and chances of death.

2. Incentivize good health with patient-centric communication

Patient-centric communication touches on a patient’s personal values beyond their health, such as family, self-esteem, and personal growth.

A patient-centric communication style may involve motivational interviewing strategies. Use the OARS acronym: Open-ended questions, Affirmations, Reflective listening, and Summarizing. This helps nurture potentially straying patients by fostering more empathetic patient-provider interactions.

This style of communication can help close gaps in care. In patients whose providers received patient-centric communication training, odds of adherence increased by more than 150 percent.

Consider a patient who takes medication for a heart problem. They may say, “I can never remember to take my pills.” The doctor can then affirm the patient is capable of taking control of their health, engage in reflective listening, and suggest a routine that easily fits into their lifestyle.

3. Use texting to reduce gaps in care

Text messages can help healthcare organizations bridge gaps in care in two ways. First, texting patients can improve treatment adherence. For example, research on patients with coronary heart disease showed daily text reminders increased medication adherence by almost 3x and improved blood pressure outcomes. Second, text message campaigns can be sent to specific patient population groups. The messages can prompt them to enroll in risk-based programs or provide patient education specific to their condition.

4. Improve patient communication with technology

Health systems miss more than 30 percent of all phone calls. And it’s estimated less than 20 percent of those callers leave a voicemail. This leads to information gaps, no-shows, and negative phone experiences. In the short term, it may cause patients to reevaluate where they get their health care. There are two consequences to this: The health system loses a patient. And the patient experiences a gap in care as they look for a new provider and wait for an appointment or potentially neglect care altogether.

Reduce hold times and improve show rates by implementing a conversational text messaging patient communication platform. Four out of five smartphone owners want their healthcare providers to text them, and 90 percent of texts are read within three minutes. Texting patients — and making sure they can text you back — eliminates the frustration and missed calls of relying on the phone.

5. Guide the conversation

More and more patients are doing online research prior to doctors appointments. While online information is a great source of patient empowerment, it can also cause tension and disagreements with providers when it comes to concluding a diagnosis or treatment plan.

Steer patients in the right direction by sending patient education by text message. Patients will feel at ease openly discussing the topics at hand, and not blindside providers with questions or concerns.

6. Reduce no-shows to reduce gaps in care

Numerous studies have shown that some form of appointment reminder, especially text messages, helps close gaps in care caused by appointment non-adherence.  In a 2016 study including 186 pediatric clinic patients or parents, those who received a single text reminder were 15 percent more likely to attend their appointment. WELL clients have seen even greater improvements with customized cadence of appointment reminders. For example, Eisenhower Health reduced its no-show rate by 71 percent.

A customizable appointment reminder system can help your patients get in the door while also preparing them with relevant pre-appointment instructions.

7. Coordinate care with unified communication

On a single day, a patient with a chronic condition may have an appointment with a specialist, get a scan, have blood work done, pick up a prescription, and receive a patient survey. They could receive multiple calls and messages from different numbers about these services. The result is confusion and “message fatigue” — contributing to gaps in care.

Instead, ensure patients receive all correspondence in a single text thread. Send from a secure, trusted source — a number from within your health system. Not only does this build trust — patients know who’s texting them — but also it allows you to combine messages into a single text. The better patients understand their care, the easier it is for them to follow through. ♥

Kids need the vaccines we already have

On a lazy summer afternoon while pushing my son on the swing outside, I thought of the coming school year.

I ran through the list of things to get done before school started. Suddenly it dawned on me, “We didn’t do his seven-year-old well child visit this year!”

Both my children get their well child visits in April. But with the COVID shutdown, parents and providers cancelled appointments in record numbers. They were never rescheduled.

Why hasn’t my provider contacted me?

I could have been distracted by making dinner, work, and the thousands of other things that are currently occupying my mind. But because of my background in healthcare, I realized this is a problem. A big problem.

Vaccination rates down due to COVID-19

Across the country, vaccination rates plummeted with the COVID-19 pandemic, especially among children over the age of two. Data gathered in the Vaccines for Children Program showed vaccinations fell below 50 percent of pre-pandemic levels in March and April compared to the previous year averages in several states. Washington, D.C, Texas, Maryland, and Pennsylvania were hardest hit.

And from mid-March to mid-April, doctors in the program ordered 2.5 million fewer doses of vaccines and 250,000 fewer doses of measles-containing vaccines as compared with the same period in 2019.

Consequences of delayed vaccines

While my children aren’t due for immunizations, thousands of others are. And when those immunizations are missed, it could mean severe consequences.

Stanford College of Medicine and Baylor College of Medicine published a study in 2017 indicating that a five percent drop in the number of children ages 2 to 11 who received the MMR vaccine would triple the number of annual measles cases in this age group. The MMR vaccine is an inoculation against measles, mumps and rubella.

“We have a tenuous handle on measles disease now. It’s all dependent on very small increments of vaccination,” said Yvonne Maldonado, MD, professor of pediatric infectious diseases at Stanford and an expert on vaccination.

As we anxiously await a vaccine for COVID, perhaps our primary concern should be obtaining the vaccines already available — vaccines for diseases that once ravaged the United States.

HHS expands access to vaccines

The U.S. Department of Health and Human Services (HHS) issued a ruling August 19, 2020 designed to increase access to vaccines and decrease the risk of vaccine-preventable disease outbreaks. The amendment authorizes state-licensed pharmacists to order and administer vaccines to children ages three through 18 years.

“As a pediatric critical care physician who has treated critically ill children suffering from vaccine preventable diseases, I know first-hand the devastation to the child – and to the family and community – of a death or severe brain damage that could have been avoided by a safe and effective vaccine,” HHS Assistant Secretary for Health Brett P. Giroir, M.D.  said, calling vaccines the “cornerstone of public health.”

Patient outreach could improve vaccination rates

When I consider the impending outbreaks of diseases we once had under control, I want to think the problem is temporary. As children return to school in the next few weeks, they will necessarily reschedule those missed visits and catch up on their vaccine schedule. Immunization levels will return to normal, especially with the HHS ruling making access easier.

But, as an increasing number parents are loath to discover, many schools are staying closed.

So I wonder again, why haven’t I heard from my doctor? Even a simple text message could prompt me to schedule an appointment.

A 2019 vaccination campaign launched among 11 WELL clients reached a total of 115,992 patients, and 5,731 responded to ask questions or make appointments. Many providers are in regions imminently at risk for a measles outbreak.

Today this kind of outreach could have measurable effects in preventing new outbreaks on top of our current pandemic.

I’m not waiting for the text message. But for everyone who is, let them know, “Hey, our office is clean, you can wait in your car and not run into any other patients. And your kids really need to get those shots!” ♥

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