Listening to the Voice of the Patient: Medical Adherence and Innovation

If you had a chronic or possibly life-threatening disease, wouldn’t you be dedicated to taking the medicines that were prescribed to make you better?

It sounds perfectly logical, but in reality, only about one half of the people in developed countries who have a chronic or life threatening disease take the doses of prescribed medicine. Some stop taking their medicines before they are supposed to and others never make it to the pharmacy at all.

In health care circles, this is called medicines non-adherence and there can be serious consequences for it, including the need for outpatient medical care or a hospital stay. While no one is sure how much it costs, it is estimated that $100 billion is spent on excess hospitalizations in the United States alone. In addition to the high financial cost, non-adherence is also reported to be the fourth leading cause of death in the U.S.

Why don’t people take their meds?

Non-adherence is a complex issue. Regardless of whether a person has diabetes or asthma or cancer, they sometimes forget to take their medicines, find the schedule of taking them difficult, or can’t afford what is prescribed. Attempts have been made to address these issues and some have worked, but not on a widespread basis.
In general, people create their own logic about whether they do or don’t need medicine; with recent research consistently showing that around 70% of non-adherence in chronic disease is intentional. Common barriers are perceived risks of overmedication, side effects, becoming addicted to, or resistant to the treatment. Many question whether they really need as much medication as they are prescribed.

These concerns are rarely discussed with health care providers (HCPs), with non-adherence remaining largely a hidden problem, but it is starkly present in pharmacy assessments of the amount of time it takes for a patient to finish or refill a prescription. Many patients feel too guilty to raise the problems they face with their HCPs.

Understanding the patient

The more we understand about the beliefs and behaviors that drive people to take their medicine the better we can come up with potential solutions to mitigate the risks. It’s an issue of which GlaxoSmithKline (GSK) and the pharmaceutical industry as a whole are keenly aware. And while the industry alone can’t provide the solution, it can help in a variety of ways.

Pharma companies are starting to include an adherence strategy in the design and delivery of medicines based on a deeper understanding of patient needs. For example, we’re considering medicine-taking regimes that factor into account the time and place patients take their medicines and can adjust for occasional missed doses. We’ve also learned that one size doesn’t fit all when it comes to adherence and that it’s important to focus on a patient’s disease and overall treatment rather than just an individual product or brand. Recognizing that some of these interventions will take time, there has been a significant focus on finding faster solutions for faster impact by linking what we know about patient behavior with digital technology.

Technology can play an important role in improving adherence  to medicines in many ways; for example, by providing  customized information, sending on-time reminders, or
remotely monitoring a patient’s vital signs. The adoption of technology isn’t a total solution, but can contribute to designing, testing, and implementing more effective and
customized ways to help patients to take their medicines.

The collision of innovation and adherence

More than 235 million people globally have asthma and it provides a good example of a condition that can be very well managed, yet isn’t. In the European Union (EU), approximately 50% of people with asthma don’t have it under control. GSK has put a great deal of effort into trying to improve that figure and initially tried
to address adherence issues with health care providers. But after spending a significant amount of time focusing on control assessment tools and guidelines, their work took them back to patients, who, for a variety of reasons, weren’t taking their medicines properly.

The GSK team had a strong desire to do something different—something innovative—using technology to help improve asthma control. Based on the recommendations and insights they collected through research with patients and physicians, they came up with a smartphone application, or “app,” called MyAsthma, which was first made available in the U.K. in 2011. The purpose of the app was to engage patients in their own asthma management through a program that allows self-monitoring and access to tailored content, offering both education and agitating positive behavior change.

Once MyAsthma is opened, the customer is profiled both to determine their level of current asthma control and for their individual asthma beliefs, needs, and concerns. This
profiling enables individually tailored messages to be sent at intervals, according to customer preferences, to address specific behavior changes and linking in to relevant educational content. This approach had been shown in academic research to lead to a sustained increase in adherence. In addition there is a range of patient engagement hot spots, including self-monitoring through the Asthma Control Test (ACT) score, providing individual feedback on their disease control as a barometer of the effectiveness of their medicines, and even actions that can be taken based on the local pollen count.

The ability of the tool to be used by caregivers and the information shared with health care providers, under the patient’s control, raises the potential of more effective
information exchange and the expectation that patients will be more engaged when they talk with their physicians. MyAsthma is not focused on specific medicines, but broad
disease management, and is a test of the effectiveness of applying the available behavioral knowledge into practice in the real world. The ultimate impact and sustainability will take time to determine, but evaluation is a key element, along with enhancements built on ongoing feedback. Data from the app may also have utility to further academic research in this field.

We don’t yet know what overall impact technological innovation will have on improving medical adherence, but these initial findings are encouraging. The GSK team says that innovation doesn’t have to be complicated but it does require that you start with the needs of your customer. Listen to your audience and they will dictate the right way to go.

[Editor's note: Article orignially appeared in The Role of Business in Health and Wellness.]

[Editor's note: Article orignially appeared in The Role of Business in Health and Wellness.]