Adherence Arena: Compliance or persistenceWhich is more important?

**Why persistence matters in evaluating adherence programs**



Why persistence matters in evaluating adherence programs

So youre in the market for a medication adherence solution and youre aware that adherence encompasses two distinct concepts: compliance and persistence.

This is more than just an academic distinction. There is a very practical difference between the two that can guide your thinking about the adherence solutions out there.

A trio of academic brainiacs based out of Dartmouth wrote a paper entitled A Model and Empirical Analysis of Patient Compliance and Persistence in Pharmaceuticals that drives home this distinction in a startling way.

First, they define compliance as the patient refills the prescription in a timely fashion. In other words, gaps between refills means missed doses.

They define persistence as the patient continues to refill the prescription. Simple enough.

Now, heres where it gets interesting.

The authors analyzed refill data for 262 different chronic medications over a one-year time period, based on a large database provided by Catalina Health Resource.

They analyzed the data with a key thought in mind: that total days of therapy lost can be decomposed into days lost due to non-compliance and days lost due to non-persistence.

What they found was that for the average drug, the breakdown over a one-year time period was as follows: Days on therapy: 30%; days lost through noncompliance: 18%; days lost through non-persistence: 53%.

Clearly, the main goal of a medication adherence solution should be to encourage the patient to keep refilling!

Sure, preventing a skipped dose here and there via reminders or various devices can certainly help whittle down that 18%, but thats more of a sidebar.

What you really want to do is to motivate patients to stay on the wagon.

So here is a hint: In evaluating the results of any adherence study or program, pay close attention to the patients who were lost to follow-up and not included in the analysis.

Those are the ones you need to reach.

Katrina S. Firlik, MD, is co-founder and chief medical officer of HealthPrize Technologies, LLC (http://www.healthprize.com/). Prior to HealthPrize, she was a practicing neurosurgeon in Connecticut. She is also the author of Another Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside.


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