June 3, 2015
As a doctor, Marcello Tonelli knows why he recommends medications and instructions to his patients. As a researcher, he’s come to understand why his patients with chronic diseases—the leading cause of death and disability—can’t always follow his advice.
Patients want to follow doctors’ instructions, but sometimes they can’t because of where they live or a lack of money.
It can be difficult and expensive—even impossible—to pay for medications or get to appointments with specialists.
Added to this is that schedules are largely chosen by health-care workers, says Tonelli, a researcher funded by Alberta Innovates – Health Solutions (AIHS). “You have an appointment. You are expected to be there at this time and then comply with all of the instructions that follow, whether they’re related to diet, activity or attending services.”
Those expectations may be logical and important, but aren’t always practical for patients.
This is where the Interdisciplinary Chronic Disease Collaboration (ICDC) comes in. The Calgary-based, AIHS-funded team began in 2009 with the goal of making the treatment of chronic diseases fair, efficient, effective and more affordable.
Led by Tonelli and Drs. Brenda Hemmelgarn and Braden Manns, both AIHS-funded researchers and U of C kidney specialists, the ICDC brings together researchers, Alberta Health Services decision-makers and doctors to find innovative ways to reduce and eliminate barriers caused by geography and low income. To achieve this, the ICDC is designing and testing ways to help doctors and pharmacists care for patients with chronic diseases.
One possible solution, proposed by Hemmelgarn and pharmacist Ross Tsuyuki is to train rural pharmacists to create care plans for patients who can’t easily get to a family doctor.
“Legislation has increased what pharmacists can do,” Tonelli says.“Pharmacists are highly trained and under used, and they often have a very long relationship with patients.”
The ICDC has teamed with Alberta Blue Cross to lower drug premiums on certain medications and with an advertising agency to help patients learn the benefits of their prescribed medications.
“Doctors don’t really have a broad selection of messages. They all basically say ‘take this or …’ ” Tonelli says. “But advertisers craft a different sort of message. An example could be, ‘If you take this medication, you will be more likely to remain free of disability so that you can play with your grandchildren.’ ”
As part of its evaluation, the research is presented to the ICDC’s Patient Advisory Committee, volunteers with chronic diseases who share their ideas with the researchers.
“We can give our input if we see shortcomings or if something is really good in the system and must continue,” says committee member Linda Marchuk, who has diabetes.“They are willing to consult people in lay positions, somebody who doesn’t have the medical background. The doctors in this group are very, very keen to hear other ideas.”
While not all the findings are ready to use, Marchuk hopes Albertans with chronic diseases will get better care.
For more information about the Interdisciplinary Chronic Disease Collaboration, visit icdc.ca.
