How can behavioural insights reduce future long term demand in the NHS?

Yesterday, we outlined thoughts on how behavioural insights might reduce future short term demand in the NHS.

Today, we’re highlighting some ways in which we might reduce future long term demand, including:

1. Maximising uptake of screening and preventative behaviours
2. Maximising adherence to treatment, and
3. Increasing uptake of remote monitoring

Behavioural insights approaches have successfully increased medication adherence

1. Maximise uptake of screening and preventative behaviours

There has now been extensive research showing that interventions informed by behavioural science can encourage uptake of screening and preventative behaviours including cervical and breast cancer screening, flu vaccination, and NHS health checks. Similar interventions could be applied across the NHS at scale to maximise engagement with these behaviours and thereby reduce future avoidable demand in the short- (eg flu) and long-term (eg late-stage cancer diagnosis). 

Behavioural interventions have also been seen to increase engagement with a range of broader preventative behaviours, including increasing physical activity and making healthier food choices (eg BIT and Nesta found that behavioural interventions can reduce the number of calories ordered on a simulated takeaway platform). Such interventions could be scaled to increase levels of baseline health in the general population.

2. Maximise adherence to treatment 

Maximising correct adherence to treatment in patients will ensure the treatments work as well as possible, potentially avoiding deterioration in clinical condition requiring intervention by the health service.

In this way, future demand may be avoided both in the short-term and the longer-term. In addition (related to the above section on supporting patients while they wait), helping patients to ‘wait well’ for their care by optimising their adherence to medication or other health-related recommendations could help ensure they are fit for their treatment (eg surgery) when it comes, rather than potentially having clinically deteriorated and requiring more extensive or complicated care as a result. 

In the past, a behavioural insights approach has successfully increased medication adherence. For example, building on the evidence that even small barriers or ‘friction costs’ can prevent a desired behaviour, BIT tried to make adherence to tuberculosis (TB) medication as easy as possible.

At the time of the trial, the World Health Organisation recommended directly observed treatment (DOT), where patients needed to be observed by their doctor or nurse while taking their medication. BIT (with the United Nations Development Programme, the Moldovan Ministry of Health and Act for Involvement) piloted a new system – Virtually Observed Treatment (VOT) – which allowed patients to record themselves taking their medications at a convenient time, rather than needing to travel to a clinic.

This intervention increased observed adherence by 92% in the VOT group compared to DOT. Oral contraceptive pill packets, which show the day of the week next to each pill to help keep track of pill-taking, are another nice example of how behavioural science can help improve medication adherence.

3. Increase uptake of remote monitoring 

Remote monitoring was mentioned earlier in this document, in the context that it would help clinicians determine when follow-up appointments were needed or clinically indicated, thereby reducing unnecessary follow-ups and avoidable demand in the short-term. In the TB example provided in the previous section, remote monitoring was seen to increase adherence to treatment, also potentially reducing both short-term and longer-term demand.

So how can we encourage healthcare providers to take up these innovative tools and ask their patients to use them?

In an experiment conducted in partnership with Imperial College London using BIT’s in-house online experimentation platform, BIT found that a variety of cognitive biases can slow the uptake of innovation, but simple behavioural or graphical information can help counteract the effect of these biases.

These behavioural tools, or similar ones, could be applied in real-world settings to help encourage the uptake of remote monitoring. BIT would recommend evaluation of such interventions to determine their effectiveness in the real-world context. It would also be important to ensure that any remote monitoring technology that was being encouraged was fully evaluated and safe for use.

The Behavioural Insights Team provides organisations with support applying behavioural insights to their local challenges. In the past, support provided by BIT has ranged from light-touch advisory support to leading full-scale randomised controlled trials. If you would like to discuss anything in this series of blogs in more detail or if you would like to explore how BIT might be able to support you to apply behavioural insights to start reducing your healthcare backlog, please get in touch: [email protected].