More than just medicine

At a glance

• This article will be of interest to brand, market access and stakeholder managers
• It provides an insight into the ever-growing responsibility of pharma in supporting medication adherence, which has become increasingly important to healthcare policy makers and payers
• The issue of patient’s adherence to medication has gained momentum in the last 12-months and there are a number of reasons for this.

In September 2011 a meeting at the European Parliament in Brussels brought together representatives from the European Patients’ Forum (EPF), the Standing Committee of European Doctors (CPME), the Pharmaceutical Group of the European Union (PGEU) and the European Federation of Pharmaceutical Industries and Associations (EFPIA).

The resulting debate called for the European Innovation Partnership on Active and Healthy Ageing and the Research Framework Programmes to prioritise medication adherence in future EU health programmes.

In August 2011, the UK Government announced the formation of a new Steering Group to ‘Improve the Use of Medicines’. This group has been tasked with finding ways to tackle the estimated £500 million cost to the NHS of patients not taking their medicines properly. This Steering Group is expected to issue an initial report in the early part of this year.

However, medicine wastage has always been a concern to the NHS, which is why the Medicines Use Review was introduced through pharmacists. On top of that, the NHS reforms clearly indicate that pharmaceutical companies are expected to be working in partnership with the NHS to provide more than just medicines.

In December 2011, the Ascertaining Barriers for Compliance (ABC) Project published a new framework for the education and training of health professionals in Europe to help manage and support medicines adherence. This is all taking place in an environment where physicians do not consider medicine adherence to be their responsibility. A recent survey by 90TEN conducted among 400 hypertensive patients in the UK, showed that 25% of them had forgotten to take their blood pressure tablets on at least one day in the last month, and only 10% of them recalled their healthcare professional (HCP) discussing tips to make taking tablets easier.

This is further supported by a Medscape study of 257 physicians that showed none of them kept track of their patients’ compliance rates. This implies that the majority of HCPs trust their patients to take their medication in the correct dosage and at the right time.

Further reports are also expected this year with recommendations to curb medicines wastage and improve patient outcomes in Europe. So we can only hope that these, and the new ABC framework, will help begin driving awareness of the importance of adherence from an educational and goal-driven perspective.

Increasing importance to Payers

Patients and health outcomes are now at the centre of policies and stakeholders are increasingly working together to support this. Poor medicine adherence carries a huge cost, both in terms of patient safety and quality of life. It also presents a serious problem for health systems, leading to inferior health outcomes, unnecessary treatments and hospitalisations.

Providing adherence support for medicines has never been more important in these times of austerity. Healthcare systems are now evaluating drugs on real world outcomes rather than on clinical trials. An adherence strategy not only differentiates a brand, but it also emphasises your commitment to stakeholder support and improves health outcomes.

While electronic monitoring of patients’ medicines adherence is becoming standard practice in clinical trials involving chronic diseases, most patients are left to their own devices outside of the controlled environment.

Stakeholder support

It is important that we do not lose sight of the impact HCPs have when it comes to motivating and supporting patients throughout their treatment.

The time an HCP can allocate to each patient is very limited. Educating the HCP in motivational interviewing techniques, tooling them up with questionnaires and making their patients’ adherence part of their own performance criteria is one approach, but this is only possible if they have sufficient time to spend with the patient, to assess their adherence regularly and consolidate their motivation into persistence.

A patient adherence programme, with a solid value proposition that supports the HCPs’ management of their patients’ condition and medication adherence, is a valuable asset to any busy HCP and fits well into an ‘adherence trust pathway’.

Building a value proposition

For a healthcare provider to engage with a pharma-sponsored adherence programme, they need to understand the value proposition it brings –in supporting their relationship with the patient, in terms of complementing their treatment, reinforcing their advice, keeping them closely informed about the patient’s progress and supporting the dialogue between them and their patient. It also needs to support the patient to manage their condition more holistically and not just provide medication reminders.

New technologies to support adherence

There are a number of new medication event monitoring systems (MEMS) that can help HCPs track whether patients take their medication. These include the Proteus smart pill, which increased compliance by 50 per cent in a small Novartis patient study. The pill runs on an electric charge generated by the patient’s stomach acid, which is detected through the patient’s body via a patch on their skin. The patch provides the HCP and patient with information such as of when the pill was taken and the patient’s heart rate.

Vitality’s GlowCap is an award-winning product that illuminates, plays a melody, sends a text message or calls a phone over a wireless network to prompt patients to take their medicine. Its embedded ‘push to refill’ feature connects automatically to a pharmacy to request repeat prescriptions.

PA Consulting introduced a new ‘Inhaler of the Future’ in 2011, which issues personalised doses, monitors the environment and provides analysis to the HCP.

New smartphone apps are available that show patients how to inject, use asthma inhalers, take their blood pressure, and change their lifestyle to manage their condition more effectively. But not every patient has a smartphone and, indeed, not everyone is a savvy user of digital technology.

As part of a comprehensive patient adherence programme, market research should be conducted to demonstrate how relevant these technologies are to the patients and to highlight any geographical differences before introducing them into an adherence programme.

But they should not be used in isolation. The key to building a successful adherence solution is to ensure that the right tools are deployed for the target audience and then built on over time in response to patient demand and through solid evaluation.

A combination of the right technology and the right level of education is key to a successful adherence strategy. An agreement to adherence between the healthcare professional and patient at the point of prescribing is essential.

The product life cycle

For a new product that is about to launch, consideration needs to be given to understanding the HCPs likelihood to engage with a patient adherence programme from the start or whether a tiered approach would be more suitable. Prescribing a new or different product to a patient comes with a unique set of questions and discussions that are required between the physician/nurse/pharmacist and the patient to instill their future concordance to the medication.

Research shows that an average of 17 per cent of patients on a newly-launched treatment are likely to join an adherence programme within two years of the product launch, however this statistic increases up to 25-30 per cent for patients who are on a more established product.

Watch this space

Pharmaceutical companies are an integral part of healthcare systems. In the last year, some key players have recognised this and restructured to develop centralised adherence strategies and work with national and local pharmacists, physicians and payers to ensure that patients are taking their medicines in the right dosage, and at the right time.

As Richard Bergstrom, EFPIA’s Director-General, said, “A medicine that is sold but not taken is a waste for everyone.” 

The author:

Carole North is joint managing director at 90TEN Healthcare

She can be contacted at carole.north@90ten.co.uk