Here is a distillation of the learning, approaches and techniques that have significantly increased patient adherence rates over the past 20 years. Whether applied to patients with life-threatening diseases or simply addressing lifestyle challenges affecting compliance, they’re proven to help significantly impact the chronic problem of patient non-adherence.


Lack of patient adherence continues to plague the healthcare industry. We all know the statistics— billions of dollars in lost Rx sales; billions more in increased healthcare costs due to poor health outcomes. Millions of people are now “talking” about the problem… and attempting to take steps to ameliorate it. But the reality is that little of what’s been “done” has worked. We’ve tried reminders (phone calls, e-mails, text messages), devices (digital pill bottle caps, alarms, pill boxes), education (why patients should be adherent) and incentives (free trial, co-pay discounts, rewards programs). The results barely scratch the surface of this enormous challenge.


While there is no “magic bullet” to change patient behavior, the best solutions lie at the heart of the real problem—

Patients don’t “like” Rx therapy; they don’t want to be “controlled” by their medications; and the idea of “taking a pill every day” just isn’t consistent with their self-perception.

If patients simply “forgot” to take their pills every day, we could solve the adherence problem with reminders. The reason we have such a significant problem is that, regardless of what we, their doctors, family or friends have to say, patients simply don’t want to take their Rx medications.

To make matters worse, our industry just can’t seem to truly integrate adherence messaging into patient communication efforts. Our tendency is to “silo” everything—professional & consumer; online & offline; acquisition & retention. But, to the patients, all these activities are completely intertwined. For example, we know that:

  • Positive physician/patient relationships are “critical” to patient adherence
  • Patients interact with us across channels, and our messages must be consistent at every point of exposure to be most effective
  • Patient retention isn’t only about them “opting-in” (if you’re lucky, only 20–30% of patients will ever opt in, and many of them will discontinue therapy anyway).

We need to address the problem of non-adherence at every patient touch point (pre- and post-Rx)

Where do we go from here?

We’ve studied the problem of patient adherence for the last 20 years. We’ve tested different techniques, messages, and offers to see what works and what doesn’t. Our greatest successes (20+% increases in patient adherence) have been realized through applying the core principles of behavioral psychology. Before you push your brand at a prospect, you need to engage them. Appeal to their self-interest. Get them to assess their risk. Then, lead them to:

  • Consider that they may be a candidate for Rx therapy
  • Accept that it’s right for them (the same way they view brushing their teeth, taking a daily vitamin or buckling their seat belts)
  • Incorporate the medication into their self-perception, how they view themselves as a person

As you develop your consumer and patient communications, here are 10 helpful tips that have been proven to enhance patient adherence and should be considered as you develop every communication whether consumer acquisition or patient retention:

1. Patient adherence begins at the very first exposure (before the 1st doctor visit)

Many emotions—including denial, apathy, and despair—keep patients from seeking help and taking their medications as directed. That’s why effective DTC advertising must go beyond simply communicating awareness. It must also help patients “accept” the need to treat their symptoms/condition. Until patients have internalized the need to take action, they won’t. When designing your DTC efforts, make sure they help prepare the patients to see his or her doctor. Be sure to also leverage multiple touch points (think “surround sound”) to reinforce these messages in many different ways such as sound bites, longer-form education, videos, discussions, etc.

2. Effective patient-provider interaction is essential

Studies show that the #1 predictor of patient adherence is the quality of physician/patient relationship. The great irony is that doctors and patients often speak different languages…doctors discuss efficacy and outcomes; patients discuss symptoms and lifestyle issues. The reason 30% of all Rxs are never filled is because many patients leave their doctor’s office not trusting that these Rxs are right for them. When creating physician leave-behinds, DTC promotion and in-office materials such as Starter Kits, brochures, and sample packaging, it’s important to make sure they support an informative physician/patient dialogue. Do that effectively and watch your patient adherence rates increase!

3. Engage patients early in therapy

The opportunity to improve patient adherence is greatest in the first two to three months of therapy. Almost without exception, if patients are going to drop off, they do so in this critical 60–90 day period. Those who stay on therapy for 90+ days are likely to remain adherent for a long period of time. That’s why it’s important to ensure all your patient communications (DTC, in-office, CRM, etc.) are timed to immediately engage patients, address their psychological roadblocks to treatment and Rx therapy. Make sure you highlight calls-to-action to help them get more information. Also, consider applying the following three communication techniques to all your patient communications:

  • Personalization

    —a 1-to-1 communication technique that acknowledges their health condition and provides empathy

  • Personification

    —allows patients to see themselves and the potential consequences of their inaction

  • Projection

    —helps patients visualize success, giving them a roadmap for action so they can see themselves successfully taking control of their condition

4. Remove roadblocks to staying on therapy

Over the past 20 years, we’ve seen consistent results by leveraging a combination of the following five critical success factors in all patient communications:

  • Education to set appropriate expectations
  • Self-management tools to convert education into action
  • Incentives to motivate/reward behavioral change
  • Family support to ensure patients don’t feel “isolated”
  • Patient/Provider interaction to reinforce key messages

5. Provide on-demand support

Unfortunately, most patients taking your brand will never opt-in to your CRM program. 20–30% opt-in rates are considered quite good, but what about the other 70–80%? Opportunities exist to engage them with content “anonymously” (on-demand). Give patients access to all tools and information relevant to therapy online, regardless of whether they opt-in, and make sure they know how to access it.

6. Use patient-friendly language

For greatest impact, consider leveraging the following techniques to maximize “engagement” and ensure patients truly understand the messages:

  • Speak in “plain English”
  • Include “real” testimonials
  • Use visuals/videos
  • Write all copy to a 6–8th grade education level

7. Promote your program

A program won’t be effective if patients/caregivers don’t know about it. Actively “market” your web/support resources through all communication channels including paid search, display, iKyp, physician office materials, offline promotion, etc.

Integrate program elements into patients’ everyday lives by reaching out through multiple venues and platforms (online, in-office, mobile, etc.). Finally, use behavioral targeting to connect the right patients with program component that match up to their individual needs).

8. Leverage caregivers as an important resource

In today’s world of social media, we’ve consistently found that friends and family are an important source of information for patients. Not only that, we’ve found that the mere “presence” of a caregiver is directly related to increased patient adherence rates. While the pharma industry isn’t quite ready to wade into the regulatory quagmire of pure social media (i.e., user-generated content), it can provide friends/family with resources they can share with patients to reinforce the need to comply with therapy. When developing consumer/patient efforts, it’s worth investing the time/resources to understand specific challenges caregivers face in their different roles with patients. Be sure to build in specific components that address their needs so they can achieve better outcomes for the patients and themselves.

9. Watch for social signals

Even though the industry may not be ready to “participate” in social media, we can certainly “monitor” online signals to help us assess the effectiveness of both online and offline communications (provided patient/caregivers size is large enough to leverage social listening). Careful analysis of social listening can help you learn more about your market, assess the impact of your promotional efforts, and adjust your marketing communications program to optimize its effectiveness.

10. Measure your success

Last, but certainly not least, it’s so important to measure the effectiveness of every component—individually and in different combinations. Engage people who understand the analytics of marketing communications so you can clearly define success factors, know your costs per lead and costs per conversion. Know what’s working and (more importantly) what’s not working. The most successful patient adherence programs are continually optimized and refined—think of them as a work in progress that evolves throughout your brand’s lifecycle.

The adherence problem is not likely to go away. But you can decrease its impact on your brand by understanding that you must get patients to accept the need for therapy. Make it easy for them to make medication part of their self-perception in a positive way. Help them to see medication as a positive part of their life (like eating healthy) rather than a negative reminder of a disease or condition.

Jay H. Bolling is CEO of Roska Healthcare Advertising. Contact him at

***Brian – please redirect this address to the proper f2 address (on homepage feature code layout): fx1_ marrying_patients_to_adherence_0412

Recent crowdsourcing study data showing the impact of:

  • Female patient 50+
  • >2 calls from call center
  • >1 caregiver attached
  • = significant increase on length on therapy
  • Jay Bolling

    Jay Bolling is Executive Chairman at PulseCX. Jay is passionate about developing customer experiences (CX) that influence the decision-making process and leverage “key impact moments” (when customers are most receptive to specific communications) to measurably increase the impact of brand messaging.


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