Using the web to improve patient compliance

Carlotta Schiedek from Almirall tells Peter Mansell about the Spanish pharma firm's innovative online compliance program, recently launched in the UK.



Carlotta Schiedek from Almirall tells Peter Mansell about the Spanish pharma firm's innovative online compliance program, recently launched in the UK.



Talking directly to the patient, yet without entering the murky waters of direct-to-consumer advertising, is one of the stickier challenges facing the pharmaceutical industry in an age of untrammelled information exchange.


While the Internet and new social media throw out an indiscriminate babble of facts, opinions, comment, analysis, information and misinformation, industry finds itself increasingly left out of the loop.


Its efforts to control the agenda through conventional media are undermined by the free-for-all in cyberspace, while its communication options are hemmed in by regulations that reflect an inherent scepticism about industrys motives in reaching out to end-users.


Spanish pharma company Almirall is trying to cut through the online clutter by launching an innovative pilot compliance program over the Internet for its product Vaniqa (eflornithine), a prescription cream that slows the growth of unwanted facial hair in women.


The costs of poor compliance


With Vaniqa, Almirall faces two marketing and adherence challenges: limited interactions between patients and doctors, and the need for women to stick with the treatment until it starts to take effect.


There are many reasons for poor medicines adherence, among them side-effects, costs, age-related confusion, misunderstanding of treatment courses, or the sheer effort and focus required to manage a long-term condition.


Vaniqa has to be used continuously, and it is only after four to six weeks that impact is seen, explains Carlotta Schiedek, International Product Manager, Dermatology for Almirall.


The longer the cream is applied, the better the results are.


In the past, the company tried to get the message to the patients by using paper-based diaries and other support materials provided to doctors through sales calls.


However, the traffic into doctors offices for this indication is relatively thin - Maybe two or three women a week, Schiedek says - with the result that doctors tended to forget to hand over the support materials to patients.


Improving compliance through the Internet


The cost of poor compliance is substantial. For example, the European association of pharmacists, the PGEU, says an estimated 194,500 deaths per year in the EU are down to misdosing of, or non-adherence to, prescribed medicines, while associated annual costs run to around 1.25 billion.


For Vaniqa, the costs involve poor perceived efficacy resulting from poor compliance.


What was needed was some form of direct communication with patients.


The answer was an Internet-based compliance program, which Almirall is piloting in the UK.


Providing the program is successful, the company plans to roll it out across Europe.


The UK is one of the biggest markets for Vaniqa yet market research found that even there compliance with therapy is poor, Schiedek notes.


The Vaniqa Internet site will include supplementary information on why the treatment takes time to exert its effect.


The product acts by slowing the growth of unwanted facial hair rather than removing it, and is intended as a complement to existing methods of hair removal.


The Vaniqa compliance program


To skirt any potential regulatory complications over direct communication with the public that might tip into marketing, access to the Almirall compliance website will be by password only.


That means users will need to be identified as existing Vaniqa patients and the websites role as a channel for information and compliance clarified.


There will also be beauty tips for women.


This addresses what Schiedek describes as the main struggle with Vaniqa: its status as a prescription-only treatment for a medical condition that also falls into the realm of cosmetics.


Almirall needs to explain how Vaniqa works and the commitment required to optimize its efficacy, Schiedek says.


At the same time, the company wants to maintain Vaniqas more consumer-oriented profile as a treatment for what is generally viewed as a cosmetic issue.


Accordingly, the more interactive format of the Vaniqa compliance website will bring the initiative more into the sphere of relationship marketing and Web 2.0 applications.


As Schiedek points out, there is a confidence issue around unwanted facial hair and most women will try to conceal the problem; Almirall wants to show patients that they are not alone.


Responding to patient demand for information


Doing this online is a function of patient demand, according to Schiedek.


Market research on Vaniqa indicated that patients wanted more information on, and interaction around, the product - and if they cant get it from the doctor, they want it from the pharmaceutical company.


The intention is not, though, to exclude or bypass the doctor.


Rather, Schiedek stresses, the compliance website should be regarded as an additional support mechanism that can help the doctor as well as patients ensure that Vaniqa is used optimally.


This is an innovative approach, especially given the continuing deadlock over the European Commissions legislative proposal to ease some controls on the provision of prescription drug information to the general public. 


The current Spanish presidency of the European Union has already decided not to discuss the patient information proposal any further during its six-month term, citing the incontrovertible need for interventions by healthcare professionals.


Last month, a coalition of 29 European organizations - spanning patient and consumer groups, health insurers, hospitals, healthcare professionals, drug experts and medical journals - issued a statement arguing that the Commissions proposals were of no added value to European citizens. 


Their only rationale seems to be to benefit the commercial interests of pharmaceutical companies by expanding their markets and helping them to build brand loyalty. 


Certainly, there is cause for scepticism.


The history of DTC advertising in the US has been far from exemplary.


And in too many cases - clinical trial data being an obvious example - the pharmaceutical industrys declared commitment to transparency has proved selective.


Patient information and social media


Yet the technological framework for patient information is expanding at an altogether different pace.


Mobile telecommunications and social media are just two fast-growing phenomena that could transform the model for interactions between pharmaceutical companies, healthcare professionals and patients.


In Progressions: Pharma 3.0, Lynn OConnor Vos, chief executive officer of Grey Healthcare Group, posits mobile-driven health (m-health) as the next revolution after networked computers, one that is already reshaping the health ecosystem by driving compliance, significantly improving health outcomes and expanding access for the underserved.


As OConnor Vos notes, mobile phone ownership easily outpaces Internet access in developing as well as developed countries.


With m-health, the mobile phone becomes a surrogate health coach and advisor, she says, enabling a two-way communication cycle, connecting and sharing information between providers, patients and caregivers.


The Almirall Vaniqa program is an attempt to become part of that communication cycle.


The logical next step would be to extend these efforts into social media.


For one thing, it raises the question of how, and how much, influence companies can have over dialogue conducted through these forums.


All the same, Schiedek points out, the flow of negative information about pharmaceutical products through the Internet or other new media happens already.


The onus, then, is on industry to get involved and find out how the process works.


The rewards of social media


Social media and Web 2.0 technologies are all about moving beyond a one-way communication paradigm, and the Almirall program is designed to make the most of this.


Information now flows in multiple directions, it is constantly morphing, and no centralized authority controls the message, Ernst & Young concluded the Progressions report.


And theres the rub for industry. Social media carry inherent risks of viral effects.


While these could very well work in a companys favour, they are just as likely to blow up in its face.


Pharmaceutical companies - or at the least their legal and regulatory affairs departments - are understandably nervous about venturing too far into this uncharted territory until they have a better handle on key issues around responsibility and liability.


Yet the rewards could be substantial, particularly in a cost-conscious healthcare environment where data mining - whether by companies, regulatory agencies, health technology assessors or payers - is becoming a crucial determinant of product value.


As Ernst & Young comments, the collected experiences of thousands of patients living with a disease and taking treatments for it are a treasure trove of data that is, at present, completely untapped.


Patients have already taken the initiative. As things stand, they are trying to get as much information as they can from the Web about pharmaceutical products - and industry needs to address that, Schiedek says.


With its online Vaniqa initiative, Almirall is taking the first steps.


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