Medication non-adherence: what can the pharmaceutical industry do to prevent this “silent killer”?

We all know how difficult it is to finish a week-long course of antibiotics. You might imagine that people with chronic debilitating conditions would be more driven to compliance and inclined to follow doctors’ orders, but the research shows that as much as 50% fail to take their medications as prescribed.⁽¹⁾ Despite the best efforts of healthcare professionals, patient support groups and the pharmaceutical industry, medication adherence remains a key challenge. The consequences of non-adherence are manifold including poorer patient outcomes such as unsatisfactory quality of life, increased hospitalizations and death as well as increased costs to the healthcare system.

With an increasingly aging population, and increasingly complex medication regimens, non- adherence is a problem that is only set to get bigger. The reasons behind non-adherence are multiple and complex and include factors related to disease, drug, education, age and socio-economic status to name a few.⁽²⁾ Unfortunately, there is no one-fits-all solution. In a survey of over 4000 prescription drug takers, a whopping 31% believed that missing doses of their medication would not have a negative impact on their condition, while 39% admitted “taking breaks” from their medication.⁽³⁾ Clearly there’s a need to educate on the importance of adherence, but also one has to wonder why so many feel the need to take a break. What lies behind this- is it, for instance, tolerability or affordability issues? My mother takes breaks from her heart medication for family celebrations, as she blames her medication for making her feel too tired to revel in these family gatherings. Each problem requires very different solutions and until we find the answers to these and many other questions, efforts to creative effective patient supports will fail. Adherence solutions delivered by the pharmaceutical industry, from nurse-services to information leaflets, patient websites and apps have had mixed results (assuming the results of the intervention were even measured). One thing is clear; successful adherence strategies are more likely when the patient participates in the co-development of the solution. And with today’s patients being more vocal, more empowered and more willing than ever to take responsibility for their own health, there’s never been a better time to get them involved.

Given the billions of euros in preventable costs to the healthcare system, even a 5% improvement in adherence has the potential for far reaching consequences. So, we have to ask-what can the pharmaceutical industry do to improve patient adherence? As a “beyond the pill” service, adherence strategies should, at the very least, be considered for any drug coming to market.

Within the pharma industry there are several things that can be done to create adherence supports that really work:

1. Start with the end in mind, or in this case the end-user. Don’t make assumptions. Let the patients tell their own stories. Listen to their experiences, spend a day ‘in their shoes’, and dig deep to learn what their real needs are and why they are not taking their medications. Gather the key insights and after identifying the pain points, continue to work with these patients to co-design sound, tailored solutions that are aligned to patient needs.
2. Sure, there may seem to be an insurmountable number of regulatory, compliance and budgetary challenges that lie between you, the patient and this patient-centric solution. Be brave. Bring all the stakeholders (internal and external) to the table: compliance, health outcomes, medical, primary and secondary healthcare providers, patients, carers and anyone else you think could add value. With a shared commitment to a tangible end goal, interventions that bring about positive behavioural change are achievable.
3. Embrace digital. Digital can help both in identifying problems and providing solutions. Social listening research is a powerful way to help identify common issues across a patient community. Over 80% of US adult internet users, use the internet to search for health/treatment information.⁽⁴⁾ Patients like to talk to each other; they relate to people like themselves. They appreciate the opportunity to share their challenges, their experiences and to learn from the hard-earned wisdom of fellow patients. Moreover, patients are willing to embrace digital. There is a significant cohort of patients who know they could be better and want to be better and would welcome the addition of pharma supported digital aids. A recent US survey has revealed that 23% of US patients would willingly use a Siri or voice-activated app to help them stick to their regime.
   
   

At nitro we partner with pharmaceutical companies, healthcare professionals, patients and tech companies to improve patient outcomes through digital. Contact us to learn more.

References

1. WHO. Adherence to long-term therapies: evidence for action. 2003.
2. Hugtenburg J, Timmers L, Elders P, Vervloet M & van Dijk L. Patient Preference and Adherence 2013:7 675–682.
3. DRG market research.
4. Fox S & Duggan M. Health Online. American Life Project. 2013.