Did you know that your chances of dying from medication nonadherence are about 10 times greater than dying of homicide? And that number grows to about 30 times greater for someone who is over the age of 50. Thanks to pillsy for pointing out those startlingly statistics in the 2018 article, “15 Frightening Stats on Medication Adherence.” That is frightening and a bit shocking—and it is not easy to shock people who work in the life sciences with statistics about adherence.

Because if you work in this industry then you have probably heard that up to 30% of prescriptions are never filled. And somewhere between 20% to 80% of patients who do fill their first prescription stop taking it within the year, depending on which study you read. And if you do keep up on your adherence studies, then you know that not all of them agree on the causes behind nonadherence.

In 2015, the AMA released an article, “8 Reasons Patients Don’t Take Their Medications,” and all eight of them were intentional, including fear of side effects, cost, misunderstanding about the need for medicine or the time it takes to see results, too many medications to take, a lack of symptoms, concern over becoming dependent on medication, depression, and mistrust over a physician’s choice of prescribed medication.

Meanwhile, in 2011, Express Scripts did a pilot with 600,000 of its members and found that nearly two-thirds of nonadherence was due to unintentional reasons such as inattention and procrastination. The breakdown, which was published in its 2011 Drug Trend Report, was 39% of nonadherent patients simply forgot to take their medications, 10% procrastinated on getting their refills, and 20% did not renew their prescriptions on time.

What Can Be Done to Address Adherence?

“Traditional adherence approaches such as a refill reminder or patient brochure can only take your brand so far,” says Andi Weiss, Lead Behaviorist, Partnerships & Advocacy at MicroMass Communications, Inc. “The most effective adherence solution should be based on a behavioral science framework that identifies evidence and support for each specific situation. Patient barriers need to be understood and analyzed from the patient perspective and used as the foundation for the solution, rather than basing decisions solely on brand challenges.”

Abigail Mallon, SVP of Innovation and Chief Compliance Officer, VMS BioMarketing, agrees and says that one way companies can accomplish that is to work to personalize patient engagement through tactics such as a welcome call, patient assessment, and motivational interviewing. Then they can offer services like two-way text messaging or video chat based on each patient’s preferences. “Multiple touchpoints build trust and a strong relationship that may lead to behavior change and better adherence,” she adds.

Working to better engage patients may also require pharma to partner with other stakeholders in healthcare.

“As pharma does not usually know who its end users (patients) are, or how to directly contact them to make an offer to enroll in an adherence program, the industry can partner with payers, PBMs, providers, and pharmacies to add enrollment scale to adherence programs,” says Tom Kottler, CEO and Co-founder, HealthPrize Technologies. “The best adherence program is just a tree falling in the forest with nobody there to hear it if patients do not enroll in the first instance. Plus, these constituencies can provide pharma with valuable prescription refill and clinical data to validate adherence program performance.”

Technology’s Growing Impact on Adherence

The adherence problem has also resulted in new companies emerging on the market with solutions leveraging the latest technology to try to solve this issue. For example, Partha S. Anbil, a Client Partner at IBM Global Business Services, Healthcare & Life Sciences practice, points out three of the most popular vendors he has seen in this space.

Proteus Digital Health offers ingestible sensors placed inside of a pill, and once consumed, sends a signal to an adhesive patch worn on the body. The patch then sends a digital record to a mobile app and a web-based portal, where patients and caregivers can access dashboards to track progress, modify treatment, or intervene as needed.

AiCure uses artificial intelligence (AI) and a mobile app that identifies the patient using computer vision technology. Once verified, the patient shows the medication to the device’s camera, allowing the app to identify the drug and confirm ingestion. The app then relays this information to a web-based dashboard for the care team to review and monitor the patient’s adherence patterns.

Catalia Health developed an AI-powered companion robot called Mabu to engage with patients at home and help them comply with their care plans. The robot, which is small enough to sit on a desk or counter, interacts with patients via a built-in tablet using natural language processing and behavioral psychology, adapting to the user’s preferences over time. These daily interactions collect data about the patient, which is then sent to a cloud-based platform for providers to monitor. In addition to giving patients their daily medication reminders, the robot can also evaluate patients’ emotional state, provide general wellness tips, or contact care providers if needed.

Anbil points out that while these vendors offer intriguing solutions, they also bring about new challenges to consider:

  • Patients may not always have access to smartphones when taking medication;
  • Ingestible sensors may not activate properly once consumed, or the signal may be delayed;
  • Body patches sometimes do not fit properly (e.g., on younger children);
  • Costs for these new methods are still uncertain, and insurers will need further evidence before they start covering them;
  • The introduction of sensors, AI, and other means of tracking will inevitably lead to privacy and security concerns for patients; and
  • It is still unclear if any of these novel approaches can address the multi-variable aspect of medication nonadherence.

“Despite these challenges, these IT vendors are providing new options to reach patients in their daily lives,” Anbil adds. “There will not be a ‘silver bullet’ solution for medication adherence, but the problem will likely improve through a combination of technology and behavioral psychology that takes individual patient needs and circumstances into account.”

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