A strategy to increase medicines adherence
Adopting strategies to manage and improve patient adherence to medicines can ensure health benefits are maximised and costs related to wasted drugs and extended recovery times through poor understanding of dosing and effects are reduced.
Costs to healthcare systems continue to climb each year as a result of non-adherence. In 2013, in the US alone, $337.1 billion of waste was attributed to non-adherence, up from $317.4 billion in 20121. According to the European Federation of Pharmaceutical Industries and Associations in Europe, medication non-adherence costs governments an estimated €125 billion and contributes to the premature deaths of nearly 200,000 Europeans a year.
Rather than treating the patient as a passive recipient of adherence messaging, it’s time to actively engage the patient in effective strategies that improve adherence and health outcomes.
Nurses’ role in adherence
We designed and executed an adherence programme that included nurse case managers placing outbound calls to patients. On the initial outbound call, the nurse assessed the parity of the patient’s goals and the ability of the medication to help achieve that goal. The nurse helped ensure that the patient knew what to expect and when.
Additionally, a risk assessment of behaviours and health history that might impact successful treatment was completed. The frequency and content of the outbound calls were driven by the outcome of the risk assessment. The programme has increased long-term persistence on therapy from 35 per cent to 85 per cent at one year of treatment. Additionally, refills increased by 60 per cent.
Redefining adherence programmes
Adherence programmes that engage patients as partners in therapy should include these four categories: goals, media, activation and relationship building. With these categories in mind, adherence programmes are redefined and provide messaging that addresses patient and prescriber goals, using a medium that resonates with patients and engages them at their unique level of activation.
Aligning doctor and patient goals
Traditionally, the doctor’s goals for therapy were assumed to be the patient’s goals, and there was little discussion about what the patient wanted for an outcome. However, patients are becoming increasingly educated on their diseases and are directing their own healthcare decisions.
If a product is designed to stop progress of a disease, but not to treat the current symptoms, and a patient’s goal is to feel better, the misalignment between the product efficacy and the patient’s goal will probably lead to some non-adherence over time. Understanding the misalignment is critical to obtaining patient buy-in and providing individually tailored education.
Reaching the patient
Personalised education can be provided through a number of formats, such as mail, email, live phone calls from a nurse or pharmacist, auto-dialer calls, text messaging, push notifications, live chat or video calls. Further new means to reach patients continue to be created.
Because every patient responds differently to every type of media, it is important that a robust adherence solution provides options from which the patient can choose.
Patient activation refers to patients’ ability to manage their own health and healthcare. Activated patients are better able to articulate their barriers to success and can more easily identify interventions that will promote better healthcare behaviours. The less able may need more assistance with identifying their needs. Patient activation measurement tools have been tested and validated to help assess where a patient is in the spectrum of activation.
Finally, as we learn to partner better with patients, we need to learn a new vocabulary. Terms such as adherence, compliance and persistence are measurable standards that we use to assess outcomes. However, these words resonate poorly with patients and are often understood as being ‘good’ or ‘bad’. We need to learn how to express the ability for an individual to succeed with a therapy plan. And if the patient doesn’t succeed, we need to be able to express what part of the plan needs to be revised.
Building a sense of accountability with another person helps patients maintain progress towards their healthcare goals. Because of the trust patients put in the nursing profession, nurses can more easily build the open, honest relationship needed to achieve a sense of accountability and help patients stay on track.
Engaging well-informed patients in their healthcare decisions and gaining their commitment to treatment regimens is critical to solving the current healthcare dilemma. We need to open the door to communication with patients, and we need to continue to identify practical interventions to work in association with patients to help them meet their healthcare goals.
1According to the Express Scripts Drug Trend Report.
About the author:
Jennifer Allen is senior programme manager, Product Support & Innovation, United BioSource Corporation (UBC), a subsidiary of Express Scripts. She has more than 25 years of healthcare experience, particularly in the fields of infusions and speciality pharmaceuticals. She designs and implements commercial clinical programmes and initiatives including development and expansion of adherence programmes.
At UBC, she has directed numerous patient services projects for a wide variety of patient populations, disease states, and therapy types. Prior to her current role Jennifer was a senior programme manager.
Jennifer holds a Bachelor of Science degree in Nursing from the University of Kansas and a Master of Business Administration from Baker University.
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