The ever elusive quest for patient adherence | PDD

The ever elusive quest for patient adherence


on June 20 2012

A couple of weeks ago, Human Sciences consultant Alex Crook attended the two-day Patient Summit 2012 at the Regent’s Park Marriott, London. In this post she explores how the patient landscape is changing and some of the revolutionary technology solutions are tackling patient adherence, but asks whether technology is always the best solution?

As the name suggests, patients were at the heart of this pharma conference, which sought to highlight the positive impact that being truly patient-centric can have on the pharma industry. Particular focus was on the hot topic of the moment – patient adherence (also referred to as patient compliance, depending on who was speaking). This is where a patient follows a regime as prescribed by their clinician. Although simple in theory, in practice it is notoriously difficult to achieve as the reasons for non-adherence are person-specific and difficult to understand, making it unfeasible to have one solution that fits all.

According to the World Health Organisation (WHO), only 50% of people suffering with a chronic disease in the developed world adhere to their medication regime. The ramifications for patients are poorer health and increased (often unnecessary) deaths, whilst for pharma companies already facing large budget cuts this is financially worrying. According to research it costs the pharma industry 62% more to attract new patients than retain their existing ones. With this is mind patient adherence clearly represents a potentially lucrative and worthwhile area to pursue for all concerned.

Translating patient awareness into patient engagement

The patient landscape is changing – a new generation of health and well-being conscious patient is emerging. Supported and empowered by the internet and social media, patients want to learn, communicate and manage their conditions. Known as the e-patient, they want more information and are wielding more power and influence than ever before. According to Patientslikeme (who spoke at the conference), 22% of their users need less in-patient care because of this platform, whilst 10% of them have fired their doctors.

Patientslikeme brings patients together to share, encourage and support one another
Image credit:

Despite the cost cutting measures companies are currently forced to employ, the need for the pharma industry to get closer to their patients is stronger than ever before. By connecting with patients, benefits can be felt by all stakeholders. Patients feel in control and better equipped. Physicians feel reassured that patients are being proactive over their health and getting better individual care, which means less frequent visits and more time for others. Whilst pharma companies see adherence figures increase which has a knock-on effect on their ROI.

A personal and friendly touch – creates a strong basis for a relationship
Image credit: 

However, there is still a gap between what health engaged consumers want and what health care providers (HCPs) are delivering. Disease education is not enough by itself, it needs to enable and engage the patient to participate in their own health and use the information given effectively. A recent study revealed that patients often defer to their doctors for fear of being labelled ‘difficult’ if they ask questions.

Creating an environment of participatory care where the HCPs, patient, patient groups etc. come together and share information encourages the patient to participate in their own health decisions, which in turn helps to define treatment and operational policies. The Doctor Patient Medical Association (DPMA) is a new online forum that brings doctors and patients together. Patients are given a voice, direct access to doctors and quality information, which in turn empowers doctors to give the best care to their patients, as well as access to key decision makers and policy discussions.

Despite the DPMA there is still an absence of HCPs on social media platforms, creating a barrier to participatory care. Harnessing the power of social media to bring HCPs and patients together will be an important means for improving patient adherence. If patients feel that they can receive support from HCPs online then this provides another avenue where patients can get engaged with their health and collaboratively work together with the HCPs to bring about the best outcome.

Finding others with similar experiences on Twitter can make the feeling of isolation less of an issue
Image credit:  ©PDD


Patient + Technology = Patient Adherence??

The opportunity to hear about the experiences of people living with MS, Cystic Fibrosis and Cancer directly from the patients made an impact on the attendees at this year’s conference. Their insight into the challenges they faced when learning about and fighting their condition triggered gasps and questions from the audience. The notion of opening up a dialogue between pharma companies, HCPs and the patient to understand what they want is seen as key to developing effective patient treatment programmes, as well as building more transparent, honest relationships. Although, it is clear that there is a hole in pharma companies’ understanding of their end users’ experience and needs. Can a deep insight and a patient-centric strategy be gained just by asking patients what they want?

The reasons for non-adherence range from the practical – ability, forgetfulness, complexity of medication and storage (particularly with homeless people) to the perceptual – motivation, attitudes, and preferences. This varied set of barriers creates a challenging environment in which to tackle patient adherence. Currently tele-health, digital tools and social media are all highlighted as potential channels to revolutionise patient adherence. There is the Vitality GlowCap – a mobile phone-connected pill cap which glows and calls the patient’s home phone in the event that they have forgotten to take their medication. Similarly, sensor-enabled pills from Proteus are tracked by a sensor patch worn on the body. A mobile health app then records when a pill is ingested, tracks sleep patterns, and records physical activity levels.

Vitality GlowCap:
Image credit:

Image credit:

The GlowCap is a wonderful solution for those who simply forget to take their medication, but what if non-adherence is a result of one’s beliefs and preferences – what’s the use of the GlowCap then? What we need to do is better understand patient behaviour and what drives their actions by exploring their world. Gathering data on what patients say and their attitudes only provides half the story but digging deeper to understand the gap between patient’s attitudes and behaviours to medication regimes is fundamental to gaining deep insight, patient-centricity and ultimately patient adherence.

Understanding how and where medication fits within a patient’s daily routine
Image credit: ©PDD

What is obviously clear is that the area of patient adherence is complex. There are a multitude of reasons for non-adherence, which fundamentally boil down to the individual and their own unique factors; such as their condition, medication, expectations, socio-economic status, education, lifestyle, family etc. The role that technology can play provides an exciting opportunity but should not be looked at as the only solution. Not everyone is an e-patient and for some they never will be. For true health engagement and treatment personalisation it is increasingly important to understand the individual’s needs and behaviours.