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Personalised patient support

An age of integration and patient-centricity in healthcare has emerged and the global pharma industry has an opportunity to be at the forefront of this change

personalised patient support

By 2050, 40 million people in England are expected to suffer from non-curable long-term conditions that require management through medication, which will put unprecedented pressures on a stretched NHS to deliver essential care. Effective ways to get the most from NHS resources are crucial and medicines wastage has been identified as a key component in this challenge. Figures show around £4bn of medicines supplied on prescription through the NHS are not used correctly, with patient outcomes compromised as a result.

Understanding why a shocking 50 per cent of patients do not adhere to their prescribed treatment regimen and addressing this effectively is key to optimising medications usage and health outcomes for patients. But for solutions to offer full value to all stakeholders, they need to work in a real world setting, enabling medications to live up to their clinical trial results. 

As a result, there is an emerging trend for the innovators in pharma to provide personalised patient support programmes with a focus on improving adherence as well as outcomes. But what constitutes an effective, real-world solution that has the patient at its heart? 

Path to better adherence
Understanding what motivates a patient to avoid taking their medication, and how to change that behaviour, is the process at the core of a patient-centric approach. Up-skilling and empowering a person to be an effective self-manager of his health cannot be achieved unless we understand what's blocking him in the first place.

As Professor John Weinman from King's College London and head of health psychology for Atlantis Healthcare Europe explains: “When you consider that each patient is living an individual life and has their own specific beliefs about their condition and treatment that determine why they choose not to take their medication or change their routine, it becomes clear that programmes just based on 'reminders' or the provision of information alone are not tackling the root of the problem.” 

Understanding an individual's unique set of beliefs is the first step to driving behaviour change; information alone is not enough.  If you want proof that information alone doesn't work, just stand outside the ASCO cancer congress and see how many oncologists are smoking – all (hopefully) well informed as to the risks, but choosing to do it anyway. There is often a conflict between the information being presented (ie smoking is a risky behaviour) and the beliefs of the individual (I just want to live in the moment), which must be addressed.

And it isn't just oncologists who fit the model. It's easy to assume that a patient with a critical health diagnosis would be hugely motivated to adhere to therapy. However, we see patients with breast cancer missing chemo, and recent victims of heart attack not making appropriate lifestyle choices. Even with life-threatening conditions, unhelpful beliefs can be powerful enough to make patients risk their lives. So any good adherence programme starts with understanding the beliefs of the patient, because once they are understood they can be modified – this is where traditional patient support programmes have failed to deliver.

Investing in the patient
Our understanding of what motivates adherence to treatment has developed significantly over the last 15 years. The approach we've found to work engages with non-adherent patients by screening for beliefs that are shown to be the predictors of non-adherence in that population. This knowledge is then used to develop engaging programmes that deliver the right kind of information for individuals, plus techniques to help them evaluate, digest and utilise that information effectively. This runs alongside evidence-based tools and techniques from the discipline of cognitive behavioural therapy (CBT) that allows people to build new behaviours into their day-to-day lives. 

This multifaceted approach goes way beyond traditional information and reminder-based adherence solutions, and is based on cutting edge health psychology and a growing body of evidence.  

Evidence tells us we can make this approach even more robust by addressing three key barriers to adherence outside of the personalised beliefs space. 

1) Practical barriers to adherence
Practical barriers which might be identified in a target population, whether that is inability to get out to a pharmacy to collect a repeat prescription, or eyesight issues making instructions hard to read, a programme needs to work with identified patient needs to be effective in the real world. 

2) Relationship with healthcare professionals (HCPs)
Another key area is building rapport, trust and effective communication with a person's HCP, as this can have powerfully beneficial effects. 

3) Social support 
The third is up-skilling people to seek out and utilise support from friends, family and charities.

Real-world engagement
Our experience of working with patients in the behaviour change space shows us that however evidence-based and transformational a programme framework is, it won't work effectively unless we deliver it in a thoroughly engaging way.

Adherence ROI Modeling

“For cardiovascular conditions, the average ROI for a 20 per cent increase in the drug utilisation is 4.0:1 (hypertension) and 5.1:1 (hypercholesterolemia)

$1 more spent on diabetes medicines

= $7.10 less spent on the other services”

M. Sokol et al, 'Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost,' Journal of Medical Care 2005

We live in a world where information is consumed from beautifully produced TV, achingly cool magazines and trendy online blogs all competing for our attention. We demand engaging, accessible content that speaks to us as individuals – but have you seen a patient website recently? When you consider how voracious the appetite for information becomes when we are ill, on a whole - the quality of patient information available leaves much to be desired. If we, as an industry are serious about supporting patients, we need to create environments and experiences, which are thoughtfully designed with the patient in mind. And this starts with personalising information for the individual and delivering it in a way he wants to consume.

Opportunity for pharma 
There are those who have struggled to see the RoI for investing in adherence support and believe such programmes are a 'nice to have', or a small facet of a patient branding exercise. But a recent study by Capgemini stated: a potential revenue loss of 59 per cent resulting from medicines non-adherence – that is staggering.

Commercially, a clear argument is therefore presented around pharma supporting adherence programmes, but the impact of adherence on outcomes must also be factored in much earlier than drug approval.

The commercial benefit of an adherent patient stretches beyond RoI; if patients are equipped to manage their medication effectively – they can gain full value from it. To qualify this benefit in value terms, just consider the multitude of ways in which non-adherence has an impact from the payer perspective:

  • Wastage – costly medicines go unused/are disposed of. In the UK the National Institute for Health and Care Excellence (NICE) estimated that around £4bn of medicines supplied on prescription through the NHS are not used correctly and a total of 4.6 per cent of global total health expenditure (THE) or $269bn worldwide, can be can be lost because of non-adherence
  • Secondary care costs – increased hospitalisation due to non-adherence significantly impacts on the disease burden
  • Personnel costs – physician and consultant time is expensive
  • Poor outcomes – medicines seemingly fail to deliver value. For patients with good adherence to beneficial drug therapy, the risk of mortality is about half that of patients with poor adherence.

Studies are now also quantifying the impact adherence has on disease burden, with the impact in common areas like cardiovascular disease and diabetes being significant.

What does patient-centred collaboration look like?

An innovative example of personalised support is the OneHeart programme - funded by AstraZeneca. The programme is for people who have suffered from a heart attack or episode of unstable angina, and utilises a partnership approach with Acute and Primary Care Trusts to enrol patients. And the end goal? To improve adherence to medication and health outcomes.

Nick Jones, national collaboration manager for AstraZeneca (UK) explains: “The OneHeart programme takes a collaborative approach to enrolling patients; we have put joint working arrangements in place with Acute Trusts and work closely with healthcare professionals on the ward – allowing more patients access to the support provided on this programme once discharged from hospital.”

“Patients on this programme receive a number of personalised interventions, designed to help them make the necessary lifestyle changes to recover from ACS while taking their prescribed medication correctly. This includes a series of health magazines with content designed to target their key non-adherent beliefs that may cause them to miss-take their meds, access to a personalised web experience to guide them through the information most relevant to them, and access to a clinical contact centre if they would like to speak with a nurse” says Nick Jones.

Through a better understanding and greater commitment to addressing the issue of medicines non-adherence we can walk the talk of a truly patient-centred approach and:

  • Optimise the real-world efficacy and safety of medicines
  • Increase patient retention
  • Drive differentiation in a crowded market
  • Provide the foundation for patient dialogue that can go beyond adherence and yield valuable insight.

In an age where pharma is moving from selling drugs to providing healthcare solutions, non-adherence provides fertile ground for the pharmaceutical industry to add real value to healthcare systems across the world – but this can only be achieved with collaboration from all healthcare stakeholders.

Article by
Charles MacKinnon

managing director of Atlantis Healthcare UK

10th July 2013

From: Sales, Marketing

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