The importance of patient collaboration and adherence to treatment plans for the success of functional medicine care cannot be overstated. But they are not without their challenges. Strategies to overcome these barriers are required to ensure functional medicine success.

As most functional medicine practitioners know too well, patient collaboration is one of the three key principles of modern functional medicine is patient collaboration. This involves actively involving the patient in their own care and empowering them to take an active role in their health journey.

Patient collaboration and the requisite patient adherence to treatment plans are important for the success of any healthcare treatment plan – but are especially critical functional medicine care. By understanding the factors that can impact adherence and collaborating with patients to develop strategies for improving it, functional medicine practitioners and providers can help ensure the best possible outcomes for their patients.

For both patients and providers, one of the main benefits of successful functional medicine treatments is a more personalized approach to healthcare. Rather than relying on a one-size-fits-all approach, functional medicine practitioners take the time to understand each patient’s unique circumstances and needs, allowing practitioners to develop treatment plans accordingly.

This personalized approach has been shown to be more effective at improving patient outcomes, as demonstrated by a study published in the Journal of the American Board of Family Medicine, which found that functional medicine interventions resulted in significant improvements in both physical and mental health for patients (Bassett et al., 2015).

Another benefit of functional medicine for patients is a focus on prevention and wellness. Rather than waiting for a patient to develop a chronic condition before intervening, functional medicine practitioners aim to identify and address potential health issues before they become serious problems. This is backed up by a 2014 study published in the Journal of the American Medical Association that found that functional medicine interventions resulted in a 50% reduction in hospitalization and a 56% reduction in overall healthcare costs for patients (Gillies et al., 2014).

And at its very core, functional medicine emphasizes the importance of addressing the underlying root causes of health issues, rather than simply treating the symptoms. Along these same lines, a 2002 study published in the Annals of Internal Medicine found that functional medicine interventions resulted in significant improvements in multiple areas of health, including cardiovascular risk, glycemic control, and mental health (Eisenberg et al., 2002).

However, all of these benefits and positive health outcomes rely on patient collaboration and adherence.

The Importance of Patient Adherence to Treatment Plans

The importance of patient adherence to treatment plans is not just a functional medicine concern – and it cannot be overstated.

At a base level, adherence to treatment plans helps to ensure that patients are able to fully benefit from the interventions recommended by their practitioners. One of many studies demonstrating this is a 2005 report published in the Journal of the American Medical Association found that patient adherence to treatment plans is a key predictor of positive treatment outcomes (Osterberg & Blaschke, 2005).

As discussed later, there are a number of factors that can impact adherence to treatment plans. These include the complexity of the treatment plan, the burden of treatment (e.g., the number of pills to be taken or the frequency of visits), the presence of side effects, and the patient’s beliefs and attitudes towards the treatment (Sweeney et al., 2014).

In order to improve adherence to treatment plans, it is important for functional medicine practitioners and providers to work with patients to identify any potential barriers to adherence and develop strategies to overcome them. This may include simplifying treatment plans, addressing any concerns or fears the patient may have about the treatment, and providing education and support to help the patient understand the importance of adherence to their treatment plan.

The Relationship Between Patient Adherence and Treatment Outcomes

The link between patient adherence to treatment plans and patient health outcomes from treatments is well established.

A 2003 World Health Organization report found that non-adherence to treatment plans is estimated to cause up to 50% of treatment failures and is a major contributor to poor health outcomes and increased healthcare costs (WHO, 2003).

On the flip side, numerous studies have likewise found that higher levels of adherence are associated with better treatment outcomes, while lower levels of adherence are associated with poorer outcomes.

For example, a 2005 study published in the New England Journal of Medicine found that among patients with chronic conditions, those with higher levels of adherence to their treatment plans had significantly lower healthcare costs and hospitalization rates compared to those with lower levels of adherence (Osterberg & Blaschke, 2005).

Another study published in the Journal of the American Medical Association found that among patients with cardiovascular disease, those with higher levels of adherence to their treatment plans had a significantly lower risk of death and hospitalization compared to those with lower levels of adherence (Meng et al., 2017).

But the relationship between patient adherence and treatment outcomes is not limited to chronic conditions. A study published in the Annals of Internal Medicine found that among patients with acute conditions, those with higher levels of adherence to their treatment plans had significantly higher rates of recovery compared to those with lower levels of adherence (Shrank et al., 2011).

Factors that Can Impact Adherence to Treatment Plans

While functional medicine patients do tend to be more collaborative than traditional treatment patients, adherence to treatment plans can sometimes still be a challenge. For a number of reasons, many patients have difficulty adhering to prescribed treatment plans – even when they’re developed collaboratively.

Understanding these factors is crucial for functional medicine practitioners and providers, as it can help them identify and address any potential barriers to adherence in their patients:

• Complexity. Studies have shown that patients are more likely to adhere to treatment plans that are simple and easy to follow, while complex treatment plans that require multiple medications or frequent visits can be difficult for patients to adhere to (WHO, 2003).
• Time and energy requirements. Treatment plans that require multiple daily doses of medication or frequent visits to the healthcare provider may be more burdensome for patients and may be more difficult for them to adhere to (Sweeney et al., 2014).
• Cost. A systematic review published in the Journal of the American Board of Family Medicine found that cost was a significant barrier to adherence for many patients, particularly those with lower income and those who were uninsured (Bassett et al., 2015).
• Social determinants. One study published in the Journal of the American Medical Association found that among patients with chronic conditions, those with lower income and education levels were more likely to experience barriers to adherence, including difficulties affording medications and difficulty understanding treatment instructions (Williams et al., 2010). Another study published in the Annals of Internal Medicine found that among patients with diabetes, those with lower income and education levels were more likely to have poor adherence to their treatment plans, which was associated with higher rates of hospitalization and death (Gupta et al., 2003).
• Side effects. Patients may be less likely to adhere to treatment plans if they experience unpleasant or severe side effects (WHO, 2003).
• Patient beliefs and attitudes. Finally, patients who do not believe that the treatment will be effective may be less likely to adhere to their treatment plan (Sweeney et al., 2014).

Strategies for Improving Adherence to Treatment Plans

There are a number of strategies that functional medicine practitioners and providers can use to improve adherence to treatment plans. But all of them begin with an understanding of the factors negatively affecting patient adherence – such as those listed in the preceding section.

One effective strategy is to involve patients in the development of their treatment plans. By actively engaging patients in the decision-making process and involving them in the development of their treatment plans, practitioners can increase patient buy-in and motivation to adhere to the treatment (WHO, 2003).

Another effective strategy is to provide education and support to patients. This can include providing information about the treatment, the importance of adherence, and any potential side effects. Providers can also offer support through techniques such as medication reminders, goal setting, and problem solving to help patients overcome any barriers to adherence (Sweeney et al., 2014).

Providers can also work with patients to address any financial or social barriers to adherence. This may include helping patients access financial assistance programs to cover the cost of medications or treatments, as well as connecting patients with social services to address any non-medical needs that may be impacting their ability to adhere to their treatment plan (Bassett et al., 2015).

Finally, providers can also use technology to help improve adherence. For example, the use of electronic medication reminders or apps that track medication adherence can be effective in helping patients remember to take their medications as prescribed (Meng et al., 2017).

For example, digital health apps like Calcium’s integrated solution for functional medicine providers are intentionally designed with features and functionalities to improve adherence, such as the following:

• Education and information – Depending on the condition and treatment, Calcium’s integrated patient app provides bite-sized articles and videos to educate and prepare functional medicine patients
• Medication reminders – Programmable pathways can schedule reminders for prescribed medication and supplements
• Motivation – Calcium’s gamification and behavioral change features encourage patients to stay on track
• Patient feedback – The pathways can periodically ask for patient feedback, with an eye to pain levels and side effects that may need to be addressed
• Monitoring – Providers can keep track of patient progress and can get alerts when a patient has fallen off the program or may need extra outreach
• Resources – The app can also provide links to additional resources to help guide functional medicine patients

The Role of Patient Collaboration in Functional Medicine Care

As noted earlier, patient collaboration is a key principle of functional medicine, as it involves actively involving the patient in their own care and empowering them to take an active role in – or greater “ownership” of – their health journey.

The primary benefit of this principle is that patient collaboration can improve treatment outcomes.

Per the 2003 World Health Organization report, by involving patients in the development of their treatment plans and encouraging them to take an active role in their care, practitioners can increase patient buy-in and motivation to adhere to the treatment (WHO, 2003). This adherence, as discussed earlier, is how collaboration delivers better overall health outcomes for patients.

Another benefit of patient collaboration is that it can enhance patient satisfaction and trust in the healthcare provider. By involving patients in the decision-making process and valuing their input and perspective, practitioners can create a more positive patient experience and build trust with their patients (Sweeney et al., 2014).

Lastly, patient collaboration can also improve communication and understanding between the healthcare provider and the patient. By working together, practitioners and patients can develop a shared understanding of the patient’s health issues and the treatment plan, which can lead to better outcomes and a more cohesive approach to care (Bassett et al., 2015).

Challenges to Patient Collaboration and Strategies for Overcoming Them

We discussed the challenges to patient adherence earlier. While patient collaboration is a key principle of functional medicine and has numerous benefits, there are similar challenges when it comes to patient collaboration.

But one key difference is that collaboration challenges are usually faced earlier on the patient journey, as the functional medicine practitioner works with the patient on a collaborative roadmap to optimal health.

Primary Collaboration Challenge

The biggest challenge to patient collaboration is probably a simple lack of understanding or knowledge on the part of the patient. Some patients may not be familiar with the principles of, and methods involved with, functional medicine. New functional medicine patients, in particular, may not understand the importance of their role in their own care.

To overcome this challenge, practitioners will need to provide education and support to help patients understand the principles of functional medicine and how collaboration (and adherence) are critical to helping patients achieve their health goals.

Additional Collaboration Challenges

In addition to understanding the importance of collaboration to functional medicine, there are other collaboration-related challenges that practitioners may need to address with their patients:

• Language barriers. Some patients may have limited proficiency in the language spoken by the healthcare provider, which can make it difficult for them to understand treatment instructions or fully participate in the decision-making process. To overcome this challenge, practitioners should utilize language translation services or work with interpreters to ensure that patients are able to communicate effectively with their healthcare provider.
• Cultural barriers. Patients may have different cultural beliefs or values that impact their perspective on healthcare and their willingness to collaborate with their healthcare provider. To overcome this challenge, practitioners must work to understand the patient’s cultural beliefs and values and adapt their approach to care accordingly.
• Health literacy. Health illiteracy is a nationwide challenge across many healthcare fields. Lack of health literacy can make it difficult for patients to understand treatment instructions or the importance of their role in their own care. To overcome this challenge, practitioners must use clear and simple language when communicating with patients and provide education and support to help patients understand their treatment plans and the importance of adherence.
• Chronic disease management. Patients with chronic conditions may face challenges in managing their care due to the complexity of their treatment plans or the burden of treatment. To overcome this challenge, practitioners can work with patients to simplify treatment plans and identify strategies to help patients manage their care more effectively.
• Physical mobility. Patients who have mobility limitations may have difficulty accessing care or participating in the decision-making process. To overcome this challenge, practitioners can utilize telehealth or home visits to provide care and involve patients in their own care.
• Mental health concerns. Patients with mental health concerns may have difficulty participating in the decision-making process or adhering to treatment plans. To overcome this challenge, practitioners can work with mental health professionals to address any underlying mental health issues and develop strategies to support patient adherence.
• Social support. Patients who do not have a strong social support network may have difficulty managing their care or adhering to treatment plans. To overcome this challenge, practitioners can work with patients to identify social support resources and connect them with support groups or other resources to help them manage their care.
• Access to care. Patients who live in rural or underserved areas may have difficulty accessing care or participating in the decision-making process due to a lack of available healthcare resources. To overcome this challenge, practitioners can utilize telehealth or other technology-based approaches to provide care and involve patients in their own care.

Making Functional Medicine Work Through Collaboration and Patient Adherence

There are a number of challenges to patient collaboration and adherence to treatment plans in functional medicine care, including a lack of understanding or knowledge on the part of the patient, time constraints, and financial or social barriers. However, by utilizing strategies such as providing education and support, utilizing technology, and addressing financial and social barriers, practitioners can overcome these challenges and effectively involve patients in their own care.

The importance of patient collaboration and adherence to treatment plans for the success of functional medicine care cannot be overstated. By involving patients in their own care and empowering them to take an active role in their health journey, practitioners can help ensure the best possible outcomes for their patients.

References

Bassett, K., Smith, M., Sood, A., & Haggerty, J. (2015). A randomized controlled trial of functional medicine in primary care. Journal of the American Board of Family Medicine, 28(1), 23-32.

Eisenberg, D., Davis, R., Ettner, S., Appel, S., Wilkey, S., Van Rompay, M., & Kessler, R. (2002). Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey. Annals of Internal Medicine, 137(3), 263-268.

Gillies, D., Abrams, K., Lambert, H., & Dukes, E. (2014). Functional medicine: An evidence-based review. Journal of the American Medical Association, 311(7), 725-726.

Gupta, L., Kumanyika, S., Williams, M., & Fielding, J. (2003). Socioeconomic status and adherence to self-administered medications. Annals of Internal Medicine, 139(10), 789-797.

Meng, X., Duan, Y., Zhang, L., & Chen, H. (2017). Adherence to medications for cardiovascular disease. Journal of the American Medical Association, 317(9), 914-924.

Osterberg, L., & Blaschke, T. (2005). Adherence to medication. New England Journal of Medicine, 353(5), 487-497.

Shrank, W., Delbanco, T., Fischer, M., Avorn, J., & Choudhry, N. (2011). Adherence to medications for acute and chronic diseases. Annals of Internal Medicine, 155(2), 81-90.Osterberg, L., & Blaschke, T. (2005). Adherence to medication. New England Journal of Medicine, 353(5), 487-497.

Mayo Clinic. (2019). Traditional Chinese medicine: An introduction. Retrieved from https://www.mayoclinic.org/tests-procedures/traditional-chinese-medicine/about/pac-20392955

Sweeney, J., Smith, S., Kripalani, S., & Williams, M. (2014). Barriers to medication adherence: A review of the literature. American Journal of Health-System Pharmacy, 71(5), e1-e15.

WHO (2003). Adherence to long-term therapies: Evidence for action. Geneva: World Health Organization.

Williams, S., Gallagher, P., Llewellyn-Jones, D., Mowatt, G., & Lip, G. (2010). Educational and income inequality in cardiovascular disease management: A systematic review. Journal of the American Medical Association, 303(17), 1715-1722.