Adherence. USA style.
I recently attended the eyeforpharma patient adherence conference in Philadelphia – and as ever, the US is an interesting place to witness the development and deployment of adherence solutions.
One is constantly reminded of the scale of the country – when an organisation wants to trial a patient support program and recruits just short of 10,000 patients in the first month, or a gentleman running a pharmacy chain casually notes that they dispense more meds than the whole of Canada.
It is clear that in many respects their work is at times on the edge, driven by: the scale, and the fact that insurers and employers are significant payers (and as such can directly measure the downstream costs of non-adherence and feel that pain quite explicitly – compared to typical European models, partly excluding Germany and France). The huge scale of the country provides a further driver – primarily because it is often necessary for the solutions providers to the industry to scale up to supply these solutions, and also due to the nature of small business in America – these organisations are very well funded (by VC), and are quickly sold on (by VC), in many cases, well before the businesses are even profitable.
So – some highlights:
- The evidence of the direct medical costs of non-adherence are black and white in the US – specifically because trials can be relatively easily conducted to demonstrate direct downstream medical costs for adherent vs non-adherent patients (or similarly, patients exposed to adherence interventions compared to those who aren’t).
- There are clear bodies of work emerging that again confirm that the primary causes of non-adherence are intentional – ie, people choosing to discontinue their therapy. Patient beliefs and fear of/experience of side effects, when compared to other factors such as age, gender, race, health literacy, relationship with HCP(s) were the most powerful predictors of non-adherence. This is certainly consistent with our experience of running solutions in multiple markets outside of the US.
This growing body of work suggests that the work of predicting why people don’t adhere has largely been done – the challenge is really in the intervention. It was universally agreed that ‘one-size-fits-all’ interventions are not the solution. There were more examples of work presented, some well-grounded in evidence, some tenuously so. The good work (in my humble opinion) was being conducted by health coaching organisations targeting people with chronic diseases. These solutions focused on self-management for people living with chronic diseases. While once again their work demonstrated that beliefs are the most predictive elements of non-adherence, their interventions considered barriers to adherence and also elements common to chronic disease – such as depression (present in >30% of people with chronic disease), and further aspects such as planning, motivation, developing self-efficacy, etc.
So – an interesting expedition. Lastly, for anyone considering a stay in Philadelphia, I can well recommend a trip to Morimoto – the Iron Chef’s rather modern take on Japanese cuisine – www.morimotorestaurant.com
Hamish Franklin
Director
Atlantis Healthcare Europe
