Linking personality, treatment compliance

Could a patient personality test help clinicians improve medication and treatment compliance? Los Angeles-based startup Frame Health is testing that approach at Kaiser Permanente.

Bruce Ettinger, Frame Health's founder and CEO, said he started the company to help solve a long-standing challenge faced by healthcare providers and insurers: how to manage patients who don't stick to medication or treatment regimens and are more likely to be readmitted to the hospital. He became interested in the link between health and personality while working as a behavioral health executive.

Frame Health has developed a personality assessment to identify potentially noncompliant patients and tools that help clinicians better communicate with patients based on their personality profiles. Research linking personality types to health behaviors and mortality lends credence to its approach.

Studies show that nearly half of medications for chronic diseases are not taken as prescribed, and another 20% to 30% of prescriptions are never filled. The result is preventable deaths and hospital readmissions that cost the healthcare system between $100 billion and $289 billion annually.

Often, clinicians “feel they're ineffective, not because they don't know what to do, but because they're unable to get the results from patients that they're looking for,” Ettinger said. “We provide a tool that offers care providers the opportunity to have a better understanding of their patients.”

Frame Health has won or been a finalist in several digital health competitions. With financial support from Kaiser Permanente's Innovation Fund, the company has joined a burgeoning industry of vendors using digital tools and behavioral health approaches to improve patient engagement and compliance.

Frame Health is testing its tools in a pilot project at Kaiser Permanente in California. Starting in July 2014, after their first appointment, patients with chronic conditions such as diabetes and hypertension who previously were identified as noncompliant receive a voluntary 70-question assessment, which takes about eight minutes to complete. With questions that delve into mood and how the patient relates to tasks and interacts with people, the assessment is presented to patients as a way to help them communicate better with their provider.

The resulting insights are used to create individualized patient-care guides for providers to help patients comply with their treatments. Frame Health and Kaiser are studying how the assessments affect patient satisfaction and health outcomes, Ettinger said. Kaiser Permanente declined to comment.

To create the assessment tool, Frame Health partnered with Tulsa, Okla.-based Hogan Assessment Systems, a workplace personality testing firm. The firm revamped its business-oriented personality assessment to focus on traits that researchers have linked to health behaviors.

One trait the assessment tool looks at is neuroticism, which has been linked to cardiovascular disease, smoking and drug dependence. Another is conscientiousness, which has been linked with higher rates of exercise and better compliance with medication regimens.

There's a large body of personality research that makes Frame Health's approach potentially useful, said Howard Friedman, a University of California at Riverside health psychologist. “There's no doubt that if you have a better doctor-patient relationship, you can improve cooperation,” he said. “But whether you can do it the quick and dirty way with a short personality test is another question.”

Dave DeBronkart, a patient-engagement advocate known as e-Patient Dave because of his work in digital health, said he finds Frame Health's approach intriguing. But he cautioned that “the context makes all the difference. If my physician with whom I have a great relationship asked me to take a test like that for a good reason, I'd gladly do that. But it must not be viewed as a substitute for getting to know each other.”

Ettinger and his team are working on a mobile platform for the assessment so that patients can complete it on their smartphones. They're also working on tools for clinicians such as personalized patient communication recommendations. Frame Health is working on integrating its tools into leading electronic health-record systems.

Patients “have embraced the tool and completed the assessment in numbers that surprised us,” he said. “There's a huge latent desire by patients to want to be better understood.”

Barbara Feder Ostrov is a freelance writer based in San Jose, Calif.