Increasing adherence with patient support

Rebecca Aris interviews Zoe Barker

Health Information Limited

pharmaphorum interviews Zoe Barker of Health Information Limited on how supporting patients with their medications has increased their adherence.

Non-compliance can be a huge obstacle to achieving effective health care. The World Health Organization estimated in 2003 that approximately 50% of patients with chronic diseases in developed countries follow the correct treatment recommendations.

This represents a significant problem to pharma. Zoe Barker of Health Information Limited describes how their service, Patient Connect, has improved medication adherence and supported patients. Patient Connect delivers point-of-dispensing clinical messages to patients. Tailored alerts appear every time a relevant prescription is dispensed in one of 5,500 partner pharmacies. The service has shown to increase dispensed medication volume significantly.

Zoe speaks with pharmaphorum around the challenges of non-adherence and the impact it has on pharma.

Interview summary

RA: What challenges do you think patients face with medication adherence?

ZB: The challenges are enormous. Despite the introduction of new medicines with fewer side-effects and better ease of use, many patients still do not take these medicines as directed, even when non-adherence can have life-threatening consequences.

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“People aged 70 years and over are now taking seven medicines at once on average, which is difficult enough for anyone to manage.”

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It is estimated that non-adherence rates overall run at 40-70% within six months of patients starting therapy. This may be due to side-effects, delayed therapeutic effect, low awareness of the importance of completing medication courses, or confusion about the condition being treated.

The problem is especially marked if medicines are prescribed preventatively for essentially symptom-free conditions such as high cholesterol or hypertension, where patients feel no obvious benefit on taking a drug.

The difficulties are compounded by ageing populations with declining powers of memory. People aged 70 years and over are now taking seven medicines at once on average, which is difficult enough for anyone to manage.

Inevitably chronic diseases are particularly susceptible to non-adherence as routine or disillusion set in.

Up to 90% of diabetes patients, for example, do not take their medication consistently enough to benefit from it, while only 75% of coronary heart disease (CHD) patients take enough of their medication for it to be effective.

Even in some cancers, 33% to 50% of patients take less of their medicine than they need to.

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“Up to 90% of diabetes patients, for example, do not take their medication consistently enough to benefit from it…”

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RA: In what therapy areas do you see the biggest increase in adherence?

ZB: In particular, we address challenges such as poor adherence in therapy areas where patients are most likely to forget or neglect their medication: for example, hypertension, depression, cholesterol management, diabetes, asthma or cancer.

RA: What is the impact of non-adherence for pharma?

ZB: The impact on industry is considerable. In the first place it is financial. If patients do not stay on their medication, then sales are lost, even if the true effect is masked by pharma’s ongoing sales efforts

The attrition curve below shows the rate of loss of patients for an average drug.

figure-1-patient-connect-attrition-curve

Figure 1: the rate of loss of patients for an average drug.

In essence, pharma devotes a substantial part of its resources to filling a bucket with a very large hole in it. Once shareholders realise this, companies will re-direct resources to compliance services, so they can realise the full potential of their sales and marketing efforts.

There is also the question of reputational damage. Non-adherence represents an enormous waste of money for the health systems that are pharma’s main customers.

For example, the NHS spends more than £2 billion a year on medication for CHD. At a conservative estimate, 50% of this outlay is going to waste through poor understanding and adherence.

Moreover, the cost is amplified by reliance on expensive secondary care when non-adherence leads to sub-optimal disease management. None of this reflects well on pharma, at a time when healthcare costs in general and drug budgets in particular are under intense pressure.

With industry embroiled in a complex debate over pricing and value, it must avoid as much as possible any perception – however misguided – that its drugs simply don’t work or are creating more problems than they solve.

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“In essence, pharma devotes a substantial part of its resources to filling a bucket with a very large hole in it…”

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RA: What is the most important thing you’ve learnt about patient adherence from your work?

ZB: Patients need support. If you support them, they are better able to persist with their medication. If you don’t support them, you can count on losing around half of your patients.

Patients also need to hear the adherence message often enough and consistently enough for it to stick. While the doctor and the patient information leaflet may highlight any potential problems, too often the messages is forgotten or ignored once the patient gets home or into the routine of repeat prescriptions.

RA: Patient Connect is looking to expand into Europe, what challenges do you foresee there?

ZB: Southern Europe is nigh on bankrupt. Patient Connect plans to “head North”, where there is a reliable health economy, and where the pharmacy markets are less fragmented.

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About the interviewee:

Zoe is the Legal and Commercial Director of Patient Connect, and has many years’ experience in the field of patient communications. As a City solicitor, she co-founded Doctor Online in 1999 and Patient Connect in 2004, then known as Health Information.

Zoe’s legal and commercial knowledge in the field of healthcare ensures that Patient Connect remains at the forefront of compliance legally, commercially and ethically.

How can patients be better supported to increase adherence?