Adherence programs need more than refill reminders

For many companies conducting an adherence program, the default activity is refill reminders, and with the growth of mobile communications (mhealth), that refill reminder might simply be a text message to ring up the local pharmacy. But mhealth ought to be much more than refill reminders—which actually aren’t all that effective, says Aunia Grogan, CEO of Atlantis Healthcare (London; US HQ in Summit, NJ), who spoke recently at a conference devoted to mhealth themes.

“Even for a specific disease, ‘one size fits all’ does not work,” says Grogan. “You need to determine what problems drive patients’ nonadherence and how it manifests in them.” For example, one individual with heart disease may have experienced problems with side effects from cholesterol drugs, causing the patient to fear similar problems from the current drug, and another may have had family members die from the disease, leading to fatalistic expectations. The clinical presentation and social demographics of the two may be very similar, but the reasons for nonadherence stem from very different issues.

Atlantis, which claims to have one of the largest health-psychologist teams in the world devoted to medication nonadhernece, has conducted programs for, among others, Novartis, Bayer and AbbVie—and can do so in 30 countries from nine global resource centers. Setting up customized solutions with explicit objectives for specific drugs and specific diseases, Atlantis works with pharmaceutical companies to create programs that address nonadherence and often include additional elements, such as patient satisfaction, levels of participation in the program, and the project’s budget.

Atlantis doesn’t use reminders as a tool to obtain compliance because most patients haven’t forgotten to take their medications; rather they have made a choice not to comply. The company designs each program for the patient base, using web-based, mhealth, and paper tools as well as phone calls, including building interactive websites, launching email campaigns, using text messaging, supplying paper workbooks or magazines, offering call centers staffed with nurses, or providing counseling calls with psychologists. It also employs a customized relationship-management system, called OnTrack xRM, that captures initial intake information about a patient, uses a logic engine to determine appropriate response, and collects and analyzes results and generates client reports.