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How Do You Solve a Problem Like Non-Adherence?

May 20, 2015

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Recent research from the World Health Organisation and the Mayo Clinic on the impact of (and influences on) a patient’s ability to adhere to their treatment regime has shown that an astounding amount of patients do not follow or complete their treatment as prescribed.

The drugs don’t work

Although patients know that the medications prescribed are effective at curing or controlling their medical conditions and diseases; depend­ing on the therapeutic area, the percentage of patients who do not adhere to their treatment can range from 25% to 78%. This behaviour can drastically reduce the efficacy of treatment, which in turn leads to increased medical emergencies, increased morbidity and, in the worst case scenario, death. There are many factors that influence a patient’s ability to follow their treatment as prescribed. Just the fact that there are many different reasons, and that a single patient can be dealing with a combination of factors that influence their behaviour, makes the identification of a single solution to non-adherence almost impossible.

The known factors that affect adherence can be derived from the attributes of the patient, issues with HCPs, the healthcare system or pharma products. More specific reasons for non-adherence can include: low health literacy, poor patient-HCP relationship, lack of communication or continuity of care, having an asymptomatic chronic disease, physical impairments, the mode of administration, treatment complexity and length, side effects, or poor social support. It is obvi­ous from this long list why a ‘one-size fits all’ solution is not possible.

Several factors have a direct influence on adherence

A major concern for healthcare practitioners is the lack of time they get to spend with patients so they can properly communicate to pa­tients what to expect with regard to their condition, treatment options, potential adverse effects from medication, and any issues surrounding poly-pharmacy or co-morbidity. For the patient this type of information can be difficult to fully digest. The information is not always presented in a way that is understandable and there usually is a great deal of it, presented at a time when the patient may be under high levels of stress. Patients also need to often cope with not only with masses of information, but also conflicting information from multiple HCPs.

This can result in patients not having a full understanding of their condition, how their treatment works, or the importance of adherence. Ultimately patients want to be well, however, for many patients this requires behaviour support and education to ensure that not only do they understand the importance of adherence, but also have the tools to tackle any barriers that they face. A simple solution would be providing a patient more time with their HCP, but this is unlikely to be a practical one.

For common prescriptions such as antibiotics it has been assumed that the importance of adherence is recognised, instructions may not be as prescriptive or informative as they should be. For a patient to be told “ensure you complete the entire course” is not enough, especially if a patients symptoms disappear and they think they are cured. Information on consuming alcohol whilst taking antibiotics is a common concern, and it’s worrying that patients are satisfied with the knowledge that (depending on the type of antibiotic) the treatment will simply cease to work. This is a misconception however, symptoms of consuming alcohol whilst on an antibiotic treatment can cause a num­ber of quite unpleasant symptoms, not to mention the reduction in or a delay in the effect of the medication, contributing to poor efficacy. Understanding the effect on the patient (and the greater population) of not completing the treatment as prescribed could provide both the rational and emotional reasons for adherence.

Influencing the patient is the responsibility of all

The healthcare system can also influence patients’ ability to adhere to their treatment regime. By ensuring that the information provided to patients is appropriate and covers the issues that concern both the patient, the HCP, the healthcare system and the pharmaceutical company (that is written at a level that is informative, yet digestible by someone without a medical background) this will allow the patient to become more knowledgeable about their prescribed treatment, and more confident in self-administering, resulting in them being fully engaged with their treatment.

Poor adherence is costly for the wider healthcare system as prolonged or unsuccessful treatments can lead to secondary issues, such as increased morbidity in patients, as well as the potential for emergency or institutional care. This ultimately leads to an increased cost in care and a greater financial burden on the healthcare or social system, and perhaps the patient or their carer.

Pharma also want to see their products being used successfully to control chronic conditions and treat diseases. Supporting patients to adhere to their treatment regime with relevant and suitable informa­tion, products, tools, or services that help patients to deal with barriers can lead to better outcomes. Providing additional services can not only support the patient, but will also help the HCP in their efforts to elicit adherence behaviour.

Services that go ‘beyond the pill’ help patients to not only remember to take their medication, but also help them to understand their treatment at times when an HCP may not be available. Well-designed services can provide the motivation and behavioural change to make adherence easier and create a habit that elicits adherence behaviour. In order to do this, services, tools and products must focus on addressing the causes or problems that lead to non-adherence- not only the symptom.

Additionally, we see pharma products that can increase adherence by addressing some of the barriers or pain points that patients’ experi­ence. Drugs that can be taken once a month as opposed to every day, or that can be done at home as opposed to a long and sometimes difficult visit to a clinic, can be beneficial for adherence and ultimately patient outcomes.

Lastly, another contributing factor is the type of condition. Advances in healthcare have evolved, and in a relatively short amount of time. This means that many of the conditions that previously lead to mortality are now classified as long-term chronic conditions. The treatment of chronic diseases is long term and often complex. Typically, com­plex and long-term treatments contribute greatly to non-adherence statistics. The complexity and length of a treatment and understand­ing where a treatment may be controlling a condition as opposed to curing, can influence a patient’s ability to adhere, especially when the results are not immediately obvious.

Not adhering to treatment is costly personally to the patient, financially to the healthcare system and pharmaceutical companies. In order to effecting address the issues that cause non-adherence, the content – patient attributes, therapeutic area, the healthcare system, the treat­ment and the relationship with HCPs much be taken into account. Solutions must be tailored to the context of the patient.

No matter how effective a treatment, patients must take it for it to work as intended by their physician.

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