PM360 asked those with expertise in improving adherence/compliance what the keys to a successful program are, the impact of new tech, and examples to emulate. Specifically, we asked them to address:
- What are the best ways to design adherence programs to ensure you are addressing the biggest barriers to adherence for your target audience? What strategies are you using to determine what will be the most effective solution?
- How can pharma best use data, technology, and patient insights to more effectively measure adherence and/or gain insights into the best methods of interventions for individual patients or specific patient populations?
- What strategies, solutions, or programs have you seen or used that have been the most effective in improving adherence? Or do you have any new ideas for a solution you would like to see that you think could be effective?
When designing a patient adherence program, don’t start with the “tactics”—reminders, copay cards, disease education, apps, wearables, trackers, etc. Start by identifying not only the patient attitudes that drive their non-adherent behaviors, but the emotional drivers/connections associated with each of the functional steps in their journeys. Use behavioral science to identify and overlay the emotional barriers/drivers to ongoing Rx use and, through the integration of both the functional and emotional understanding of the customer experience (CX), identify how to best weave the brand into the patient journey so that it’s perceived to be a partner in the progress of the patients’ success.
And most importantly, identify the Key Impact Moments. Think of Impact Moments as the customer pain points where you have an opportunity to enhance the brand value proposition and directly influence it’s use and ongoing satisfaction. For only when you know these Impact Moments, can you truly create experiences that will fully engage your target audiences, drive measurable behavioral change, and increase patient adherence.
It is now well recognized that one-size-fits-all approaches to nonadherence do not work. This means that non-adherence needs to be addressed at the individual level. Each person, regardless of their diagnosis and treatment will have different adherence barriers. Health psychology-driven research helps to isolate these barriers for a specific patient population. Once isolated, these barriers can be readily assessed for each individual when they enroll into an adherence program. The interventions an individual subsequently receives as part of the program can then be targeted to address the individual’s unique barriers. The individual therefore gets the support they need, and resources are used efficiently.
Of course, it is not enough to just provide people with information. Interventions need to be grounded in behavior change techniques so they actively work to change the individual’s behavior. Depending on an individual’s need, this can include supporting the individual to learn new self-management skills, to build self-confidence, or to change the way an individual thinks about their condition and treatment. The key to offering effective adherence support is both to understand the barriers as identified in foundational research, and then to mitigate these barriers through active interventions that leverage behavior change techniques.
Pharma marketers and brand managers should first hone in on how to keep patients engaged over time. By using core tactics of gamification, paired with behavioral economics and consumer marketing strategies, marketers can create high-value interactions with patients that lead to engagement and ultimately improved adherence. It’s a proven method.
Gamification first helps establish healthy habits. Combined with education to enhance intrinsic motivation, patients are more likely and able to maintain their healthy behaviors in the long term. These game tactics hinge upon hooking users into a digital experience, so marketers can effectively keep patients engaged and motivated to take their medications as prescribed.
Game mechanics work by satisfying several human desires, including reward, status, achievement, self-expression, competition, and altruism. The mechanics behind games, from points and levels to challenges and leaderboards, are responsible for addressing these desires. Completing time-based, challenging goals, for example, brings a rush of energy and elation that keep patients coming back.
Before starting the process of designing an intervention to improve adherence, it’s essential to understand the evidence of non-adherence, including sizing and quantifying the problem and understanding its impact on therapy outcomes and cost, and the reasons why a patient is not adherent.
We recommend following a data- and insights-driven five-step approach for developing adherence and compliance solutions. First, rely on evidence generation to size the problem and its impact on health outcomes. Second, generate insights through non-interventional and observational techniques, such as biometric measurement and ethnographic approaches, as well as interventional approaches such as electronic/app-driven patient feedback. Next, implement multi-disciplinary activation workshops to bring-to-life data and research-driven insights that allow you to fuel concepts for potential interventions. Fourth, engage additional experts to design behavioral change programs and digital solutions. Finally, test, implement, and measure the outcomes of the interventions, and even course correct, if required.
Improving adherence requires “patient-centric solutions” that build on “patient-based evidence” and “listening to the voice of the patient.” Placing patients’ attitudes and behaviors at the heart of understanding adherence will lead to better adherence, improved treatment outcomes, and a higher quality of life for patients.
Technology offers a great deal of value to pharma. One of the most important aspects involving technology is the ability to uncover baseline patient habits, beliefs, attitudes, and behaviors before patients start a new medication. These intrinsic patient barriers are not related to treatment and may result in solutions that address adherence problems.
Pharma can also use technology to gain deeper insights about individuals, rather than assuming that population data can be generalized for everyone. Technology can provide insights to understand where patients are currently looking for information, how they are managing their condition, and if the patients are struggling with their treatment.
Although the potential to make an impact with technology offers great opportunity, the use of technology should be considered a cautionary tale. Introducing new technology such as wearables or trackers can add an additional burden to condition and treatment management for patients. Technology may also not provide an accurate picture of what is keeping the patient from addressing their reasons for non-compliance and adherence. Using technology in the right way can help pharma meet patients where they are and help them get to where they need to be.
It is common for pharma companies to ask doctors or nurses about the best ways to improve treatment adherence. Although their insights are no doubt also valuable for this purpose, directly asking the patients allows pharma to get unique insights into what does and does not work for improving adherence and compliance from the patients’ perspective. It is also a good way to get first-hand feedback on proposed interventions.
Just like pharma uses advisory boards with clinician KOLs, the same approach can be used to gather patient insights. However, depending on the disease in question—and patients’ performance status and day-to-day commitments—the patient advisors may not be able to travel long distances to attend face-to-face meetings. This is where technology comes in! Using technologies such as pharma-compliant virtual portals, real-time web meeting technology, and/or asynchronous but interactive online discussion forums, pharma can gain important insights on how to improve adherence, while reducing the patient burden.
Our own research, both in academic settings and with pharma clients, has shown that the causes of non-adherence are plentiful. They can include an associated stigma of taking medication, an inability to afford the full dosing regimen, simple forgetfulness, hyperbolic discounting of the negative consequences of non-adherence, and the lack of associated external cues that could help in habit formation. Individual interventions often have success addressing the patient group expressing one particular non-adherence phenotype, but fail with others because the root cause of their non-adherence remains unaddressed.
We’ve seen other industries tackle this problem with novel solutions. The financial industry has improved participation rates in retirement savings plans through automatic enrollment and automated “retirement income” calculators that eliminate forgetfulness and immediacy behavior barriers. Language learning apps such as Duolingo combine frequent multichannel reminders with gamification to overcome inertia and maintain interest levels.
The pharma industry is unlikely to find a single, magic, technological solution to solve all of the problems of medication adherence. But identifying key behavioral phenotypes for their products and developing tools targeted at the root causes of those phenotypes are likely to be the answer.
The most successful solutions use a holistic omni-channel approach that balances essential human-to-human connection with the right technology for the right patient at the right time. I believe setting expectations up front is necessary for adherence. It’s important to conduct a patient assessment, which helps to identify adherence risks, individual needs, communication preferences, and readiness to change through a personal, relationship-based approach.
For instance, we ask open-ended questions to stimulate discussion, use reflective listening, and present options for education based on preference or need. It’s important to make interventions simple, timely, and easy to incorporate into a patient’s routine. Program opt-in should be low friction—simple, easy, or automated. Proactively reach out to the patient within the first week of the prescription being written. Break down the information into manageable, bite-size chunks. Provide automated text, email reminders, and motivational encouragement messages at the right time.
All of these techniques are designed to support and encourage patients to better manage their therapy. In a pre- and post-education survey, we have seen patients who received education from one of our VMS Clinical Educators were 73% more likely to continue therapy.
We recommend solutions that target patients across three “phases” of adherence degradation that we have identified in the patient journey: Abandonment, “one and done” prescription behavior, and ongoing therapy degradation.
For example, our inOffice solution starts at the doctor’s office to help address abandonment by engaging the patient with therapy initiation information and education to help ensure they pick up their prescription. We then leverage our inPharmacy solution to directly impact the “one and done” populations by offering copay assistance at the pharmacy counter to reduce the cost burden. And we address long-term adherence degradation and all three phases collectively with our inHome solution which is the component that provides the crucial therapy support needed when the patient is managing their condition on their own in a real-life setting.
This dynamic approach delivered an average relative impact in adherence of 5.1% across all of our solutions and we observed a maximum relative impact in adherence of up to 26%. Given each solution and program impacts human behavior differently as there are other influencing factors, we’ve carved out the impact of our programs exclusively and have in fact observed these figures.