Patient Compliance – Cracking that Big Nut!
In this month’s column we look at the issue of non-adherence, the risk of bias in adherence surveys and how a better understanding of true patient behavior is critical to improving compliance.
Consider the scenario – the physician has been detailed, is sold on your brand and prescribes it to the patient. Unfortunately, the patient, perhaps unconvinced of the drug’s benefits, either doesn’t fill the prescription or fails to properly adhere to the treatment regime – that’s assuming they even present in the first place. The consequence for many patients is that they don’t get the best outcomes and end up with negative perceptions of the drug. The consequence for pharma, of course, is that drug sales are impacted and brand image is damaged.
Non-adherence is a very common problem and a big issue for pharma, especially in chronic disease areas like diabetes, hypertension and osteoporosis. The pharmaceutical industry has invested significant time and money trying to solve this issue, particularly with the use of memory aids ranging from simple pill boxes to sophisticated wireless devices. But how effective are these aids?
We recently undertook a study[i] to investigate compliance in type 2 diabetes. We were looking to address a common dilemma market researchers face – which is that compliance is actually quite difficult to measure. Traditional methods, such as diary studies, can give results where respondents are found to overstate how compliant they really are. Patients may say or recall taking their medication when they did not. The simple act of asking them to complete a diary can introduce bias into the process – the respondent becomes more compliant because the survey is reminding them to be! Electronic monitoring systems which can tell when a patient takes their medication are the gold standard but these systems don’t explain why patients do or don’t comply with their treatment program.
So we thought we would try using a research approach which would engage patients, not act as a reminder, could be self-administered and easy to manage. Research using mobile phones was ideal because we could recruit respondents and survey them at random times over a period, at key moments when they were following their regular routine. We wanted to see if this approach would elicit greater insights into compliant and non-compliant behavior.
A major finding of the study was that we did find that patients are not as compliant as they think they are. Whilst 82% said they were compliant, only 62% were really taking their medication as prescribed. We found that compliance aids, such as pill boxes, gave patients a false sense of reassurance – 90% of those who had a compliance aid perceived themselves to be compliant, when 54% of these actually were. Those who didn’t have a compliance aid perceived themselves to be less compliant – 75% - but actually 74% of these patients were found to be compliant.
The pharma industry needs to look at compliance aids and at the advice surrounding these tools to see if they can educate patients to use them more effectively.
We found certain circumstances related to compliant behavior. Unsurprisingly, we found that patients who comply are much more satisfied with their medication than those who aren’t. The more support patients are given from HCPs, friends and family, the more compliant the recorded behavior. And if they said they had a ‘good relationship’ with their PCP, then they were more likely to be compliant. We also found that routine has a large impact on compliance behavior. Eighty percent of patients who did have a routine were compliant, compared with 40% compliance from those who didn’t.
The implication for pharma is that compliance remains an issue which needs to be addressed, but it isn’t enough to give patients compliance tools and think that this is going to change behavior. And it isn’t enough to rely on anecdotal evidence because when a nurse educator hears a patient say ‘’I use a days of the week pill box to help me to remember to take my medications’ or ‘I’m really organized, I put them all in a box”, it may not be confirmation that a patient is being compliant. Understanding how a patient really integrates their medications into their daily routine and what factors really affect compliance, are critical to influencing and changing patient behavior.
For more information on the study or further patient behavioural insights, contact Mary at email@example.com.
Living with Diabetes for mobile was undertaken amongst 50 patients with type 2 diabetes in the UK in April 2013 and was a pilot study for a larger, multi-stage survey involving thousands of patients in France, Germany, Italy, Spain and the UK.