When you think about behaviors that lead to poor health, what comes to mind? Smoking? Over eating? Lack of exercise? One behavior that may not be top of mind is failure to take medications as prescribed. In fact, medication non-adherence may be more harmful to the health of Americans than many other risk factors. According to a 2012 review in the Annals of Internal Medicine1, 20% to 30% of prescriptions are never filled, and approximately 50% of medicines for chronic diseases are not taken as prescribed. This leads to approximately 125,000 preventable deaths each year.
The problem of nonadherence is not easy to solve. Many elements contribute to the challenge ranging from medication side effects, to socioeconomic factors, to lack of education or health literacy, to mental and emotional issues.
For patients managing complex specialty diseases, adherence can be especially challenging. Patients are frequently taking multiple medications, which can lead to confusion about when to take each prescription and when to refill. Patients with chronic diseases may face more severe side effects, as well as depression or anxiety about their disease. Despite common misconceptions, research has shown that adherence rates for serious conditions are the same or worse than for less serious illnesses.
The Role of Pharmaceutical Companies
Driving better patient adherence is an issue that all healthcare stakeholders can agree on because when patients adhere to their treatment plans, healthcare costs decrease and outcomes improve. For pharmaceutical manufacturers, this is particularly relevant in a time when they are increasingly being reimbursed based on outcomes.
While physicians may be in the best position to influence patient behavior, pharmaceutical companies can play a role in supporting better adherence through patient outreach programs, typically in partnership with a patient services hub.
If you are planning to develop an adherence program, a good first step is to identify an experienced patient services hub with a proven track record for delivering effective and compliant adherence programs. It is important to select a hub partner who understands the regulatory landscape due to ever-changing complexities. Connecting your own legal or compliance team with the hub team early in the process can help to ensure that everyone has a clear understanding of your company’s compliance parameters and is aligned on how to develop a compliant program.
Best Practices for Developing Adherence Programs
Even with solid planning and experienced partners, the quality and effectiveness of adherence programs can vary greatly. Below are a few best practices to help ensure your program is delivering the optimal benefit.
1. Know your patients: Every patient is unique—and it is important to recognize differences in patients when addressing adherence. For instance, some patients may be instinctively compliant to their therapy regimen and need very little support. While others may struggle with a variety of different challenges, ranging from physical to emotional to financial, which could undermine their ability to stay on therapy. By conducting validated questionnaires with patients at the beginning of their treatment journey, hubs can often identify these issues early and segment patients into different groups so they can receive more individualized support synchronized within each step of the journey
2. Understand the nuances of your disease: Just as important as knowing your patient is understanding the nuances of your disease and treatment regimen. For example, do you know the standards of care for your disease, and under what circumstances providers may deviate from it? Are there specific times when patients are more likely to experience adverse events—and therefore be at higher risk of falling off therapy? Are there early warning signs of complications that could lead to a hospital readmission? One way to glean these insights is to apply artificial intelligence (AI) and natural language processing to recorded discussions between your hub team and providers and patients. Listening to providers and patients with the support of AI can lead to meaningful insights into how HCPs treat the condition and potential barriers to patient adherence—which can then lead to more effective interventions.
3. Take the time to educate: For patients who are managing chronic diseases, one of their greatest needs is education about their medicine. While a patient services hub cannot provide medical advice, they can play an important role in reinforcing instructions from physicians and providing clarification on information patients may find confusing. Physicians may have limited resources to follow up with patients after the prescription is written, but hub teams can spend extra time with patients who may need to have information repeated or who may need education about expected side effects.
4. Meet patients where they are: Connecting with patients means understanding how they want to communicate. For one patient, a weekly phone call to provide information and support might be ideal. Another might prefer a daily reminder by text. A third might prefer to receive emails twice a month. While personalization may add complexity to your program, it can also lead to higher engagement.
5. Think about the full patient journey: Patient support programs are often too focused on the beginning of the treatment journey—getting patients to fill the first prescription. To optimize support of patients with chronic diseases, it is important to take a long-term view. Consider how you will continue to encourage adherence 6, 9, or 12 months into the therapy regimen. Your patient services hub should be able to collect data and provide insights on when patients are most at risk of falling off therapy. These analyses can help you to plan interventions at the times when they will have the greatest benefit to the patient.
Nonadherence is a challenge without a simple fix. No single individual or company has all the answers. But by connecting with patients and taking the time to support them through the entire treatment journey, pharmaceutical companies and their patient services hubs have an opportunity to keep more patients on therapy and drive better outcomes.
Viswanathan M, Golin CE, Jones CD, et al. “Interventions to Improve Adherence to Self-administered Medications for Chronic Diseases in the United States: A systematic Review.” Ann Intern Med. 2012;157(11):785-95.