The Success of a Clinical Pathway Depends on Adherence

Clinical pathways can be used to promote the standardization of evidence-based treatment strategies in order to ensure that every patient is receiving the best possible care. Yet, it is not enough to simply put pathways in place; their success depends on the adherence of both health care providers and patients to these pathways.

Health care providers must use pathways consistently when making treatment decisions. Although on-pathway treatments may not be appropriate for all patients, most agree that the majority of patients should be treated on-pathway and that the decision to use off-pathway treatments should be made conscientiously and for evidence-based reasons. Brian J Gebhardt, MD, and colleagues describe the approach taken at UPMC CancerCenter to improve physician adherence to the clinical pathways implemented within the health care system (page 33). They demonstrate that clinical pathways that provide a systematic, yet flexible, approach for incorporating new treatment strategies into practice guidelines and efficiently disseminating them to physicians can promote standardized practices. In turn, this standardization decreases inefficiency and ineffective utilization of resources, creates savings for health care providers and payers, and leads to higher patient satisfaction and improved outcomes.

Even with providers consistently prescribing treatments recommended by clinical pathways, variations in patient adherence to prescribed treatments can influence clinical outcomes. One of the ways in which patient adherence with treatment plans can be improved is through the use of patient navigation programs. Patient navigation can help cancer patients to navigate the health care system, from the time of diagnosis and throughout treatment, follow-up care, and survivorship. As oncology pathways are increasingly evolving to include these different stages of cancer care, it is important that patients are able to successfully transition between these stages and to adhere to prescribed care at each stage. Sheryl Riley, RN, OCN, CMCN, and Cortney Riley, BS, DPT, discuss how patient navigation and care coordination services have demonstrated success for improving patient adherence with care plans in order to ensure improved clinical outcomes and enhanced value (page 41).

In this month’s installment of “Clinical Pathways GPS: Government, Policy & Systems Changes Affecting Clinical Pathways,” Richard G Stefanacci, DO, MGH, MBA, AGSF, CMD, and Scott Guerin, PhD explain how principles of health psychology could be incorporated into a clinical pathway in order to improve patient adherence to treatment plans, in order to improve the likelihood of the pathway’s success (page 29).

The value of clinical pathways can only be demonstrated when they are implemented effectively. Therefore, practical obstacles that may limit their uptake in the clinical setting must be considered so that they can be overcome effectively.