How to address deliberate non-adherence

Kate Reid, general manager of Atlantis Healthcare UK, on innovative new ways to engage deliberately non-adherent patients.

Kate Reid, general manager of Atlantis Healthcare UK, on innovative new ways to engage deliberately non-adherent patients.

Finances, confusion, poor planning, and forgetfulness - they all play a major roll in why patients fail to take their medications.

But a growing body of research suggests the single largest contributor to patient non-adherence is choice.

Ultimately, its the patient who chooses to take a medication or not, and often their inner beliefs about themselves and their diseases lead them to make choices that dont align with the doctors advice. Kate Reid, general manager of Atlantis Healthcare UK, says that up to 60 to 70 percent of non-adherent patients fall into this category.

The deliberately non-adherent

These are patients who know what to do, Reid says.

They know how to take their medication, and they know when to take it, but still theyre reluctant to adhere.

Pharmaceutical companies have invested heavily in patient support programs in recent years, but most overlook the fact that their patients are deliberately non-adherentrather than just busy, forgetful, or financially strained.

If someone has made the active choice not to take a drug, a leaflet reminding him or her to take that drug wont do much good.

Its all good and well having fantastic theory, great evidence, and a strong program design, says Reid, but if no one actually knows that your program exists, or the content of the interventions doesnt really relate to the individuals it serves, it can all be a waste of time.


Understanding patients as individuals

Atlantis Healthcare designs and executes programs from the ground up.

In the past 15 years, the firm has developed more than 40 programs globally across 27 disease states.

The company also specializes in improving underperforming patient support programs.

The first key to their programs, says Reid, is understanding patients on the individual levelnot just having a full understanding of the disease state and a solid overview of the evidence, but also of patients individual beliefs and potential treatment concerns.

Atlantis Healthcares clinical team of health psychologists uses personalization algorithms to create detailed patient profiles that illuminate the best way to connect with each patient.

They have a nurse advisor contact center as well as e-mail, text message, and personalized mailing programs.

All patient relationships are tracked by way of their customer relationship management system, OnTrack.

Ultimately, if we connect appropriately through the right channels to enough patients, we will help change patients behavior through addressing these non-adherent beliefs and ensure better treatment outcomes, says Reid.


Personalized patient support programs

Atlantis Healthcare has designed personalized patient support programs for diseases across the healthcare spectrumasthma, breast cancer, osteoporosis, take your pickand has experienced impressive success in each.In a program in New Zealand in 2007, they were able to improve patient adherence to an Alzheimers drug by 35 percent at the three-month mark.

They discovered that most patients and carers felt that the regimen the doctor had prescribeda twice-daily cholinesterase inhibitorwas demanding.

Plus many of the patients and carers didnt understand that Alzheimers treatments slow the rate of cognitive decline rather than cure the disease altogether.

Atlantis created a monthly in-depth consultation with a nurse, a DVD about real life stories of families living with Alzheimers, a written guide to managing the medication, an activity diary, and a three- and six-month doctor feedback report.

Eighty-five percent of enrolled patients persisted past the three-month mark, and this specific pharma company began to grow at 6 percent per annum rather than declining 2 percent.

Where we see these programs really work is when theyre not simply a rehash of existing materials and a drug safety line, says Reid.

Instead they use validated health psychology frameworks and make an effort to address their patients individual beliefs and concerns about their condition and their medicine.


The Internet and adherence

Atlantis Healthcare is not alone in personalizing support programs. WellDoc uses technology (often cell-phone-related outreach) to create direct links with patients and improve disease management outcomes. (See story here.)

HealthHonors uses behavioral economics to create customized incentive plans for patients. Some plans include financial incentives while others appeal to competition, family, or common sense. It all depends on the individual. (See story here.)

Atlantis Healthcare has expanded its personalized approach from Australia and New Zealand to Europe and the UK, where Reid is based.

Reid says that in the future she expects this trend toward personalization to continue.

The Internet provides healthcare companies a way to be more present in the lives of their patients than ever before.

If they harness it appropriately, they have the chance to build a personal relationship with their patients, as well as a larger sense of community.

Just look at the popularity of patient forums and blog sites that allow patients to share stories and find solace in shared treatment.

Patients want to share their experiences and hear other peoples stories, so communicating in a way that people are used to consuming media, like that found in forums, can be really successful, says Reid.


Reid will be running a workshop, alongside Prof. John Weinman (Head of Department, Health Psychology, Kings College London) on practical solutions to the challenges of medicines adherence at eyeforpharmas Patient Adherence & Relationship Marketing Conference (Zurich, June 16-17). 

Click here to listen to How personalized outreach can boost adherence, a podcast with Kate Reid.
For related insight on patient compliance, see Improving adherence by listening and learning.

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