Adherence is in the behavior
Quick…the prescription drug you take once weekly has just run out. What do you do? If you answered, “Order a refill, pick it up and carry on with treatment,” you're in the majority: About six or seven out of every 10 people take their prescription as directed. But it's that 30%-40% minority that's proven vexing for healthcare stakeholders.
Last month MM&M assembled a group of experts from across the healthcare system to help understand the drivers of nonadherence, and show some possible ways forward. (Our ebook that discusses these issues in detail will be out this month.) Below are some of the ideas posed by the four different stakeholders at the table:
Academia: Most adherence interventions try one approach to reach everybody. Research shows that catch-all tactics work a little, sometimes for a short time, sometimes not for long at all, but nothing really sustains behavioral change. There has to be more effort put into attacking the issue of adherence from a health psychology approach: attempt to understand each potential adherence dropout personally. You can have the most high-tech approach, but without understanding the human behavior, it's for naught. The problem is that many interventions tried thus far have not been informed by theory.
Provider: One low-tech approach—embedding PharmDs at a facility—has been successful. They educate patients and get them to take “ownership of their healthcare.” While reimbursement is challenging, that's what's needed—at least until pharma improves at making sense of the increasing heaps of data at their disposal. Only by trying to understand behavior can patients get that sense of self-worth that makes them more compliant—otherwise, we're making decisions based on impersonal and insufficent information. Employers and large payers can facilitate adherence by rethinking deductibles for certain disease states, like diabetes.
Pharma: Again, it comes down to understanding what works for whom, and then targeting the right program to the right person. Low-tech programs do work—stapling the reminder to the bag, phone calls—the ROI is there. Every company in diabetes has a field force that works with clinicians to help educate patients. They spend time with patients once diagnosed and put on therapy, and when they can opt in. It's about creating trust between an HCP or certified diabetes educator and a patient. But the understanding of what drives nonadherence isn't necessarily behind these programs, and it could further advance them. Knowing what's motivating or de-motivating someone can help get to the crux of a problem early on.
Payer: Some simple adherence programs can lower the cost of healthcare—and payers can be good partners with pharma in running them. As the payer intervenes with members, it's trying to connect with those who have already been prescribed a medicine. Our payer panelist noted that it's not about promoting a product. If the pharma company is developing good products, they will become standards of care, and if it's helping those conditions where those standards of care are utilized, the pharma will do just fine. Payers can partner to bring value to the system and support these programs, because the decision has been made by the physician and it's the job of the healthcare team to keep patients on the medication.
Enjoy our final issue of the year. I wish you, your families, friends and colleagues the happiest of holidays. See you in 2015.