Why metrics matter in patient adherence
Andrew Tolve explores how medication possession ratios (MPRs) and tailored interventions can help drive compliance.
By on May 4, 2010Andrew Tolve explores how medication possession ratios (MPRs) and tailored interventions can help drive compliance.
For decades health professionals have published eye-popping statistics about poor patient adherence50 percent of patients with chronic diseases dont comply with treatment; 20 percent of retail prescriptions never get filled.
But the audience has been the industry rather than patients.
Now companies focused on improving patient adherence are incorporating these statistics into their solutions.
Frankly, most patients and consumers dont know or dont care about the measuring sticks we use in the pharma industry, says Lucas Merrow, CEO of Eliza Corporation.
They have a lot of other things going on every day, and compliance metrics are not top of mind, to say the least.
The key, therefore, is to incorporate metrics into tailored interventions that engage consumers and motivate them to act.
Its what you actually do about these metrics that matters, says Merrow.
Choosing the right metric
Various statistical methods are used to measure patient compliance: continuous measure of medication gaps (CMG), proportion of days covered (PDC), estimated level of persistence (ELPT), daily electronic stamps (MEMS caps).
One of the most reliable and readily used is the medication possession ratio (MPR), calculated by taking the number of days of medication supplied within a refill interval and dividing it by the number of days in that refill interval.
Adherence specialists gravitate towards MPR because of its standard, well-understood definition, which allows the metric to be applied consistently across therapeutic categories, populations,time frames, and studies.
A disadvantage of MPR is that it doesnt reveal what percentage of days the medication was actually taken, just what percentage it was dispensed.
From a practical, real-world perspective, there is no one best measure of adherence, says Merrow.
We advise incorporating multiple measures whenever possible, augmented with patient-reported data, to triangulate and validate actual adherence values and behavior.
Customizing a message
Some patients respond directly to statistical motivation, Merrow says.
Those with a competitive streak, or who like comparative benchmarks, often fit into this cohort.
Dr. Murat Kalayoglu, chief science officer of HealthHonors, a Healthways Company, says that if statistics are going to work on their own, they generally work best as short-term motivators.
But the MPR has to be explained in very simple, intuitive terms for it to make an impact, he says.
The better solution, in his view, is to integrate these statistics into customized solutions.
HealthHonors has created software that looks at patterns of how people engage, identifies how those patterns vary, and then determines the right mix of reinforcements for each individualfinancial incentives, motivational emails and texts, or free literature.
Statistical feedback can be one of those reinforcements, says Kalayoglu, as long as a rich science in framing [guides] the messaging.
Messages that show improvements motivate some, while messages that show regression motivate others.
The most appropriate framing can be determined empirically for different populations, he says.
Context is king
Merrow agrees that if statistical measures are used as motivators, they generally shouldnt be delivered in isolation.
They need to be delivered with the appropriate background, explanation, and context, and they need to be made applicable and real to the patients daily life, he says.
That means understanding if the patient responds better to authority and expertise, potential health consequences, impact on family, or financial implications and incentives.
Eliza Corporation uses MPRs as trigger values for outreach and control variables for tailored, multi-faceted messaging.
The metrics and values themselves are of little use without understanding the individual patient attitudes, motivations, and preferences that drive adherence behavior, says Merrow, and then using this understanding to deliver relevant, personalized interventions and content.
For more on MPRs, see Patient compliance and specialty pharmacy products.
For more on HealthHonors incentive programs, see Using incentives to improve patient compliance.