Many years ago an experienced and well-respected marketer for one of the world’s most successful pharmaceutical brands once described improving medicines adherence to me as the ‘holy grail in pharma’.
Ten years on and those words resonate with me as much now as they did then, and improving medicines adherence has been such a difficult problem to solve.
Rarely has a subject matter generated such debate and polarised opinion so distinctly; the understanding of it eagerly pursued by academics, pharmaceutical companies, communication agencies, payers and even governments.
A matter of perspective
One of the challenges with medicines adherence is that the key stakeholders tend to look at the problem from their own perspective.
A pharmaceutical company will see improving adherence as a means of replicating clinical trial results in the real world and a powerful adjunct to improved brand sales. Payers see adherence as a way to reduce medicines wastage and improve patient outcomes. Physicians see it as a way to ensure that, once a diagnosis has been agreed, a treatment plan is followed that will lead to an improved clinical outcome.
However for the patient, adherence is accepting a diagnosis, following a set of instructions and potentially facing a lifetime of dependence on medication.
So, the very people that we are trying to help the most, the patient, arguably have the least input into the decisions and agreed actions.
A different viewpoint
Perhaps then, focusing on adherence is like trying to look through the wrong end of the telescope. Ultimately, the term ‘adherence’ creates a disconnect between a patient and a healthcare professional. It reinforces a hierarchical relationship where the patient is disempowered and that could be the very reason why so many adherence interventions fail.
Making progress
Without a doubt, we have made significant progress in our understanding of the causes of non-adherence and the complex and dynamic interplay of the multitude of factors involving the patient, the treatment and the healthcare provider.
We have modelled and proven the impact in terms of increased morbidity, mortality and financial burden that medicines non-adherence represents.
So why, with all of this knowledge, do we look to produce such blunt tools to effect change in such a complex area?
Segmenting patients as having a ‘high’ or ‘low’ risk of non-adherence oversimplifies a potential solution and does little to identify with, and understand, the patient as an individual person with unique needs.
For example, there are many patient support programmes that provide external nurse call centres for patients, but these risk disempowering the HCP team and do little to ensure seamless integrated care from the patient’s perspective.
Many adherence solutions focus on the reminder applications which further demonstrate the disconnect between theory and practice. In a recent review of 229 adherence apps, it was found that 98% focused on timer-based reminders, but none provided routine support or contextual cues – meaning none was truly personalised to the patients’ needs.
Creating partners, fostering engagement, solving problems
The time is long overdue to elevate patients as true partners and active decision-makers in their disease management and treatment course. To enable a new discussion with their healthcare professional, one based on the patient as an equitable member of the healthcare team. The healthcare professional may be the expert on a particular disease, but the expert on an individual patient is the patient themselves.
We need an adjustment in perspective on how adherence is viewed by turning our attention to truly understanding the very unique problems that individual patients want to solve in the context of their own life.
What’s so interesting is that when you look to solve real-world problems that patients have, the results augment and strengthen the HCP/patient relationship, with improved medicines adherence an attractive and valuable bi-product. The EarthWorks has employed this philosophy to develop award-winning patient support programmes in chronic conditions such as asthma and HIV, and rare, complex conditions such as pulmonary arterial hypertension.
There is a growing body of evidence that suggests that patients who are better engaged in their disease understanding are more connected with their healthcare team and their treatment, have improved outcomes, utilise less emergency care and are more adherent to their treatment.
The pharmaceutical industry has an opportunity to take a fresh approach to delivering patient care, and the journey promises to be exciting and rewarding for everyone involved.
Richard Jones is patient services director at The EarthWorks, a specialist patient engagement, insights and health technology practice
