Do Doctors Have a Role to Play in Improving Adherence?

The March 2013 World Congress meeting on adherence was held in Philadelphia and brought together a wide range of adherence stakeholders including insurers, pharma, adherence solution vendors and academicians. Dr. Kevin Volpe from the University of Pennsylvania gave a wonderful presentation describing some of the ways that behavioral economic insights can be used to promote better adherence behavior. But he said one thing I found particularly striking: Healthcare providers—the folks on the front lines with the patients—don’t have much of an impact on adherence.

Obviously, I don’t agree with that proposition. After all, I write this column every other month or so on how physicians can have a tremendous impact on patient behavior and how pharma can learn from and leverage these approaches. But Volpp has a point: Doctors have been seeing patients, caring for them, and counseling them for quite a long time and yet adherence so far has been little better than abysmal.

While doctors’ efforts to promote adherence (to the extent there have been any) haven’t solved the problem yet, it doesn’t mean that doctors can’t get patients to use their medications. The large variation in adherence between the populations of patients cared for by different doctors only goes to show that doctors can have an influence. All of the available tools that pharmacists, insurers and drug companies have to enhance adherence can be used by doctors, and because of doctors’ close personal relationships with their patients, even bigger effects on adherence can be expected from them. Changing doctor behavior—not the easiest thing to do for a pharma marketer—is a potentially powerful tool to influence adherence.

Many of the same principles for enhancing patients’ adherence behaviors apply to influencing physician behavior, too. Just as educating patients on adherence seems to have little effect, educating doctors about the magnitude of poor adherence is unlikely to be sufficient by itself. Changing incentives is a more promising approach; I’m quite confident adherence will be a high priority for doctors when doctors’ pay is more closely tied to their patients’ adherence and/or treatment outcomes.

One attendee at the World Congress said that, so far, reaching out to physicians to give them information on particular patients with poor adherence has not been well received. This is not surprising considering I would not expect a positive response from my patients if I accused them of poor adherence behavior. A little sugar is probably a better approach, starting off by reporting to doctors what a good job they are doing with patients who are highly adherent. Plus, we might want to get the standard pharmacology textbooks used in medical school to at least mention the adherence problem.

  • Steven Feldman, M.D.

    Dr. Steven Feldman is Professor of Dermatology and Public Health Sciences at Wake Forest Baptist Medical Center. Steve studies patient adherence at North Carolina’s Wake Forest Baptist Medical Center. He is also Chief Science Officer of Causa Reseach, an adherence solutions company (, founder of, and author of “Compartments” and “An Illustrated Dictionary of Behavioral Economics for Healthcare Professionals.”


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