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Touching the avoiders

Why do patients visit the doctor only to ignore the advice and throw the drugs away?

Could you walk with a broken leg? What if doing so was a matter of life and death; your life and death?

Before you try to answer, consider the case of Joe Simpson: an experienced mountaineer, he and a colleague, Simon Yates, set out to climb the Siula Grande in Peru, a mountain 6,344 metres in height - almost 21,000 feet.

They became the first mountaineers to reach the summit by way of the West face, but, blighted by terrible weather, disaster struck on their descent when Simpson fell and broke his leg. The only way down involved Yates lowering him on a rope 300 feet at a time before following.

The alarming situation became terrifying when Simpson fell into a crevasse, with no way of climbing back up. Yates had a tough decision to make, and he made it. He cut the rope.

Simpson fell further into the crevasse, but finally (and luckily) landed on a ledge. While Yates made his way down to base camp, sure that his friend was dead, Simpson began an even more remarkable journey than his ascent to the summit.

He found a route to climb out of the crevasse and, literally, crawled over rocky mountain terrain for three and a half days without food, water and in terrible pain. When he arrived at base camp, he was in a bad way but survived to write a best-seller about his ordeal, which is now also a film, called Touching the Void.

Altruistic approach
In times of real peril it seems that we will do anything to save our lives. Yet, why is it that the incredible is sometimes possible, if the simple can be a real challenge?

Paying for and taking a prescription drug, renewing the prescription and then taking more of the medicine, has so many of us faking it. Is drug compliance such a mountainous task that even Joe Simpson would shy away from it?

One American doctor was sued, albeit unsuccessfully as it rightly turned out, by the family of a 43-year old man who had died while he was one of her patients. He had not only decided he wouldn't take vital medication for a serious heart condition, against the advice of by the physician, but also told his family that the doctor had pronounced him to be in the best of health.

Hence, the court case: it was only before the eyes of the law that it became clear just how little he had done to save his own life.

The doctor in question now employs a very strict compliance regime, enabling her to follow how closely patients are adhering to their prescription regimen.

What are the real costs?
The subject of patient compliance is made interesting by the human trait of failing to act, even though the results of not doing so can be fatal or, at best, lead to a much-reduced quality of life. However, for those in the pharma industry, the subject takes a more serious turn when business and care issues are also considered.

Depending on where you source your information - in Europe or America - the financial costs of poor patient compliance are estimated to be £17bn (Ä24.8bn) or $30bn. Either way, the serious implications for pharma's financial health are clear.

More important that the financial cost, however, is another estimation - that non-compliance causes 340 deaths a day.

The truth is that patients, doctors and pharma would all benefit from better patient compliance.

Currently, pharmaceutical companies spend six times as much trying to attract new customers as they do to retain existing ones. Indeed, a recent Harris Interactive online survey of 2,507 US adults, conducted in March 2005, revealed that 33 per cent of those prescribed drugs to take on a regular basis, reported being `often' or `very often' non-compliant.

Other research in 2002 revealed that of 440,000 prescriptions written daily by GPs, one-fifth did not reach the pharmacy. In 2001, unused prescriptions worth some £230m were returned to UK pharmacies.

One of the more alarming statistics is that 65 per cent of patients with chronic illness are reported to slip into non-compliance after only six months of treatment.

Yet, when you consider the investment required to deliver the product in the first place - the R&D costs, launch of a product and preparation of doctors etc - the actual cost to pharma firms runs much deeper than the headline costs of unused scripts.

There are a number of solutions to the conundrum of patient non-compliance and, despite the obvious inherent health dangers, its worrying prevalence.

Naturally, patients have varying levels of ability across age groups. Their ability to absorb information is wide ranging, and is further tested by the fact that they are already in the stressful situation of being ill and concerned for the future.

Most likely they will need more than one prescription, which extends the number of instructions and guidelines they have to follow for healthy compliance. Additionally, the packaging for some medications can often be unclear and difficult to follow for patients or non-medically trained people.

Help me help you
Of course, patients also contribute directly to their own ill health; non-compliance is not solely about drugs. People fail to curtail lifestyle vices, establish dietary changes, reduce alcohol intake and quit smoking, even when advised to do so by a GP.

Yet, as with most things, communication plays a huge part. In the age of the internet and medical dictionaries in homes, patients receive too much inconsistent information.

It is not uncommon for GPs to encounter non-compliance brought about by patients receiving incomplete, unsubstantiated and often downright wrong information about the medications they're taking, as well as any potential side effects.

Unfortunately, the key sources of such information are quite often friends and family, which is why integration of communication channels is important.

Where, once, patient compliance information was limited, technology now affords greater opportunities to be more flexible and innovative, but in a way that helps rather than bombards.

Technology is vital in delivering effective compliance programmes and the range of communication tools at our disposal now include telephony, SMS messaging, internet, email and many more.

There are now multi-media environments offering interaction with campaign targets in real time via the web. This is one way to reach users who want anonymity in a one-to-one setting; it provides confidential communication with a specialist advisor from the privacy of the home.

More knowledgeable patients suffer less from confusion, anxiety and, as a result, non-compliance.

The statistics show that patient compliance, which can be as low as 50 per cent, can be improved upon through encouragement and education. As such, GPs are more likely to prescribe treatments that are supported by a helpline service.

Advances in compliance programmes signal a change in how pharma is working,
as it allows for one-to-one servicing, the enhancement of feedback (especially through focus groups), the empowerment of patients, and their accompaniment through care and support networks.

The business and patient care drivers for increasing numbers of pharma competitors pursuing patient compliance are plain to see: greater efficiency, the retention of patients, better return for the years of R&D, and of course, a better informed and more comforted patient base.

The pharma industry has set out on its own climb, to conquer patient compliance challenges and achieve new heights of provision. Potential rewards are substantial for all concerned; perhaps in some cases, even a matter of life and death.

As Joe Simpson can testify, meeting tough challenges really is possible.

The author
Peter Carragher is the director of client services at the essentiagroup

2nd September 2008

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