Triathlon and Nonadherence

“We educate triathletes; we do not train triathletes.”  This concept is very difficult to understand, but let see what happens in Medicine to explain our approach to triathletes.  The following is from Medscape:

James F. Sweeney

May 07, 2019

The True Cost of Nonadherence

Hippocrates warned about nonadherence. "Keep watch also on the fault of patients which makes them lie about taking of things prescribed," he is alleged to have said.

Much has changed in the 2500 years since Hippocrates laid the foundation of modern medicine, but his caution about nonadherence still holds true.

A review in the Annals of Internal Medicine^[1] estimated that medication nonadherence causes 125,000 deaths in this country, placing it between stroke and Alzheimer disease as the sixth most common cause of mortality. It's also responsible for 10% of hospitalizations and costs the healthcare system as much as $289 billion a year. About one quarter of new prescriptions are never filled, and patients do not take their medication about half the time.

With the greater emphasis on value-based care and population health, more attention than ever is being paid to the problem of nonadherence, but there is no single proven way to correct it. And it's clear that current efforts are falling short.

Well, Medicine started to see why we have a high failure rate when treating patients.  The reason is simple:

Treating a nonadherent patient is frustrating for a physician and can feel pointless. In addition, nonadherent patients can hurt a practice's bottom line, as medicine shifts to outcome-based reimbursement.

We do not have the problem of reimbursement when coaching but we should.  Many countries and Federations have a huge budget without results.  Reimbursement based on outcome should be the way to go to be effective and professional in what we do.  This is something touched a bit in a previous post.

28 févr. 2019

Triathlon and Perseverance

The bottom line is that coaches have not idea of what makes an athlete succeed just as doctor have limited knowledge of why patients do not follow instructions.  If the coach is correct and there is a plan to follow we should look at the problem of nonadherence.  We have been looking at it for a long long time and have tried hard to overcome it but my guess is that we are 50/50 regarding achieving adherence.  This is without touching the point of how many points (subjects) of adherence we want to achieve.  Adherence to paying attention is our main adherence; adherence of nutrition and recovery are easier to achieve.

We try using electronics:

 How effective tech has been is the subject of debate and conflicting studies. What's clear, however, is that tech will continue to be a part of comprehensive adherence programs.

Jason Rose, MHSA, CEO of AdhereHealth, said the most effective technology will rely on data, but add a personal touch. For example, AdhereHealth (formerly PharmMD) scrapes data from pharmacies, physicians, insurers, healthcare systems, and elsewhere to identify instances in which patients are not filling prescriptions, not taking medication, or otherwise not adhering to treatment plans.

We have known Dorian Connix since he finished 10^th in the Junior World Championship held in New Zealand.  Our competitor was 9^th then.  Connix continue learning because he had multiple point of adherence to his life plan.  Nonadherence is the main cause of failure; even if the plan is not so good, it works if there are many adherence points from the part of the athlete.  “It is better a bad plan than no plan.”