5 Ways to Tackle Patient Non-Adherence

When was the last time you stopped taking your medications as soon as you felt better, even though the physician had recommended an extended treatment?

Nitin Raizada

Therapy non-adherence happens to the best of us. And it has been rampant for centuries, first mentioned back in 400BC when Hippocrates noted that some patients tended to lie about taking their medications correctly and then complained about the implications.

Arindam De

Patients face numerous challenges that can keep them from taking their medicines. These include complex regiments, fear of side effects, inadequate insurance cover, and a lack of information about their condition and its treatment. In the United States alone, non-adherence accounts for up to 50% of treatment failures and around 125,000 deaths, each year. With increase in the incidence of chronic conditions and an exponentially growing aging population, these numbers are expected to rise even further.

Durgagauri Sabnis

In addition to poor clinical outcomes among patients, therapy non-adherence also affects pharma’s bottom line. Moreover, non-adherence creates a perception of treatment inefficacy among patients. This inaccurate assumption reduces pharma’s brand equity, customer retention rates, and profit margins.

Why have pharma’s current adherence-promoting initiatives proven ineffective?

Despite the evolved understanding regarding the magnitude and repercussions associated with therapy nonadherence, pharma companies have been unsuccessful in controlling or eliminating it. Here are some reasons why:

• A one-size-fits-all approach for their adherence-promoting programs
• Siloed program operations
• Lack of data-driven insights to optimize program performance
• Subpar patient experience
• A myopic mindset toward future innovations

How can pharma companies tackle therapy nonadherence effectively?

Pharma companies lose $600+ billion each year due to patients not taking their medications. We present five strategies that can help them improve the return on investment from their adherence promoting initiatives and drive positive health outcomes for patients.

1. Personalization of solutions through AI and data-driven segmentation

Patients face diverse barriers to take their medications as they go through the treatment. Hence, personalization is key while creating customized care plans that help drive adherent behavior among individual patients. 

To enable this, pharma companies need to adopt an artificial intelligence (AI) and data-driven, three-tiered segregation model that ensures laser-sharp targeting. Here's what it entails.

a. Segmentation: Identifying key therapy- and disease-related barriers faced by patients to define primary personas.

b. Risk stratification: Classifying personas into low- and high-risk groups based on their socioeconomic- and lifestyle-related factors that can result in non-adherent behavior.

c. Behavioral modeling: A patient’s behavioral insufficiencies can negatively impact their ability to remain adherent. By closely working with counselors and social workers, pharma companies can identify behavioral patterns that confound a patient’s attitude toward their medications and apply these insights to further clarify the personas.

Combining this three-step framework with relevant solutions and a performance measurement loop can help pharma companies improve the impact of their adherence programs and enhance patient satisfaction.

2. Collaboration with key stakeholders in the healthcare ecosystem

With the growing understanding of the complexity of the non-adherence issue, it has become apparent that the responsibility to remain adherent does not solely lie with the patient. Stakeholders such as physicians, pharmacists, nurse practitioners, payers, and carers, play crucial roles in ensuring that patients remain on their treatment. By collaborating with these stakeholders and ensuring their participation in their adherence programs, pharma companies can reduce patient drop-offs at key inflection points and foster adherent behavior among patients.

For example, by collaborating with doctors, nurses, and nurse practitioners to counsel, educate, and reassure patients, pharma companies can overcome several drivers leading to intentional non-adherence. Some of these include the lack of information about the disease and treatment, fear of side effects or dependence, and confusion surrounding complex treatment regimens. Alternatively, organizing workshops or webinars that educate caregivers regarding the long-term benefits of following the physician’s instructions can also positively influence treatment adherence among patients.

3. Focus on patient experience

So far, pharma companies have had an undivided focus on engaging physicians and honing connections with them. However, with patients being more conscious and in charge of their healthcare journeys, pharma companies need to re-think their engagement models and devise innovative ways to engage them. While several forward-thinking pharma companies have built the infrastructure and capabilities to cater to these changing patient needs, numerous others have struggled to change mindsets and transform business models.

Unfortunately, taking that much-needed plunge toward patient-centricity is no longer an option for the ones lagging behind. Irrespective of the therapeutic area, it has become imperative for all pharma companies to build two-way interactions with patients and deliver value even before they use the drug. Providing patients with personalized support solutions and a superior experience across touchpoints will help pharma companies build long-lasting connections with them and drive better health outcomes.

4. Adoption of a data-centric approach to optimize program performance

As pharma companies gear up to introduce novel patient support programs (PSPs) to promote adherence, they also need to build capabilities to measure and optimize their performance. Identifying relevant methods to collect data, converting this data into strategic insights, building agile capabilities to execute them, and repeating this process regularly, can help pharma companies derive better returns from their adherence-promoting initiatives.

As far as performance measurement is concerned, key performance indicators (KPIs) such as program utilization, initiation, persistence, length of stay, dropout rates, and customer satisfaction scores can help determine the success of an adherence program. Depending on the nature of the program, pharma companies can also define some additional metrics to measure the performance of their tele-support, financial- and pharmacist-driven initiatives. Regardless of the measurement framework defined, it is necessary to share timely progress reports with the key stakeholders, including physicians and payers, to ensure their continued support of the program.

5. Utilization of behavioral science to motivate treatment self-management

Behavioral science explains how people can be irrational and reveals how to utilize their shortcomings to help them. Behavioral science-driven strategies have proven effective in delivering impactful interventions for behavioral change, driving patients to take charge of their health. By increasing the patient’s ability to self-manage their treatment, inculcating self-dependency, and driving proactive healthy behavior, pharma companies can enhance medication adherence and maximize the efficacy of treatments.

Conclusion

Therapy non-adherence is a complex issue with multiple drivers and severe consequences. Understanding patient needs on a real-time basis, using innovation to resolve them, and focusing on delivering a superior patient experience at every touch point can help pharma companies to foster adherent behavior among patients and drive positive health outcomes.

“Therapy nonadherence can no longer be tackled unidimensionally by only focusing on improving the management of a particular drug. It deserves a multidimensional and nuanced approach. Pharma companies need to consider lifestyle, socioeconomic and behavioral factors to come up with innovative solutions that cater to individual patient needs.

By using AI/ ML-driven technologies to identify patient challenges and to enable dynamic personalized care, pharma companies can drive adherent behavior among patients and achieve commercial success in the long run.” — Nitin Raizada.

About the authors

Nitin Raizada is VP, Enterprise Commercial; Arindam De, is Director, Enterprise Commercial; and Durgagauri Sabnis, PhD, is Manager, Product Marketing, all at Indegene.