Patient Adherence 2004-9: Has anything really changed?
Looking back over the past five years, its fair to ask, Has anything really changed? Are patients really any more empowered than they were in 2004? Has pharma truly embraced the patient agenda and have patient-focused activities and programmes been developed to reflect this?
At first glance, you could be forgiven for thinking its just a cosmetic change a nip here, a tuck there. But in reality, when you scratch the surface, the changes are more than skin deep.
Where we were
Back in 2004, everyone was still getting to grips with the World Health Organizations 200-page tome of wisdom, Adherence to Long-Term Therapies (WHO 2003) and two key messages were getting into not only the industry press, but mainstream media, too. These were, Medicines will not work if you do not take them and the now oft-quoted statistic that approximately only 50% of patients who suffer from chronic conditions adhere to treatment recommendations. Today, this would be very old news, and the focus has switched firmly to how we can address the problem and what role pharma can, and should, play in facilitating this.
At about the same time (2002), the UKs Department of Health had established the Medicines Partnership to promote the concept of concordance - or shared decision-making - as an approach to help patients to get the most from their medicines. And in 2003, the UKs Ask About Medicines campaign began, with the objective of increasing peoples involvement in decisions about their use of medicines.
At the end of March 2009, some six years later, the Ask About Medicines campaign will come to a natural close. Reflecting about the progress made, Joanne Shaw, Chair of the campaign, says:
After six years of active campaigning, we believe that [the] mission has largely been achieved. Patient involvement in decisions about treatment is now accepted as an aspiration for all. A NICE guideline has been developed on medicines concordance. More services now exist to enable people to understand and use their medicines effectively, such as pharmacy-based Medicines Use Review. And new resources have been created to enable people to make better informed choices about medicine-taking
Undoubtedly, the issue of compliance and concordance is now better understood, more widely documented and more frequently discussed. Looking at the conference program for 2009, its clear that weve moved on in our thinking. Were no longer worrying about terminology (compliance, adherence, concordance, persistence). Instead, weve switched our focus to the more tangible aspects of adherence programs. This years conference addresses more nitty gritty topics such as patient psychology, motivational interviewing, social marketing and health literacy.
Whats perhaps less clear, however, is a solid evidence base to show that the plethora of new initiatives over the past few years have succeeded in changing patient behavior and improving adherence over the medium to longer-term.
Several pharma companies are running successful patient support and compliance programs, but many are understandably reluctant to publish their full methodology and results, for reasons of commercial confidentiality. However, at the 2009 event companies, including Janssen-Cilag, GSK, NovoNordisk and Shire, will be sharing some case studies and best practice, so hopefully others will follow their example, and help the industry move forward together on this issue in the future.
Have patients risen up the agenda in importance over the past five years?
In the early days, it often seemed hard to convince colleagues of the value of the patient as a key stakeholder. Coming from an FMCG background, Id been trained in the Consumer is King school of marketing, but in pharma it seemed there was no semblance of consumer power after all, the patient (in Europe at least) had no impact in the prescribing or purchasing decision, and was mostly a passive recipient in the process. Hence, the reason why patient marketers carved their niche in patient compliance and support programs, as seemingly the only areas of possible influence.
In 2009, it feels somewhat different.
Last month, I blogged about PwC's recent report: Pharma 2020 - The Vision, which highlights the renewed focus on patients as key influencing stakeholders, and the role patient understanding can play in value creation.
Then just this week, The Economist Intelligence Unit published their new report, Fixing Healthcare, which claims that patient involvement will become even more crucial for controlling healthcare costs and improving standards in the future. Key findings included the recognition that proactive patients are stretching the system, and that patients generally must be empowered to manage their own health more effectively if healthcare budgets arent to spiral out of control.
Perhaps this will be the critical factor which marks the turning point in the whole patient empowerment debate. Previously, the pressure for patient empowerment was seen to come from a relatively small group of organized patient groups, and highly motivated individuals. There was resistance from some professional groups, as they felt their medical authority was being challenged. Today, the focus has shifted, and as the EIU report makes clear, a significant proportion of patients now have increased expectations of healthcare systems. In the EIU report, at least half of the professionals surveyed said they believed patients expectations had increased over the past two years with regard to standards of care, provision of information, involvement in decision-making and access to treatments.
So what are the implications for pharma?
All over the world governments, providers and stakeholders are discussing the looming healthcare problem the combination of raised demands and expectations, with an increasingly aged population with multiple health needs - all against a backdrop of the global economic downturn. There is recognition that were in this together, its a shared problem, and we need shared solutions and workable partnerships. Theres perhaps never been a better time for the industry to demonstrate its commitment and desire to be considered a trusted and respected player in the healthcare system.
However, future success will depend heavily on the demonstration of added value and improved health outcomes for patients.
I firmly believe that this now puts the patient center-stage, and that we need to put patient needs and wants at the very heart of future pharma strategy. We need patient-centric thinking right across the business, from initial innovation and product development, through to product packaging, product delivery and patient support and communication.
Anything else?
No discussion of the past five years would be complete without some observation about the growth and impact of social media. Way back in 2004 we were getting excited about web and mobile technology, blogs were largely for geeks only, and we were still living in a Facebook, YouTube and Twitter-free world.
Perhaps somewhat prophetically, I made a presentation at the 2004 conference entitled, The E-nabled Patient using technology to build valuable patient relationships. A delegate told me afterwards that it was very interesting but largely a load of cobblers. After all, he said, no patients ever going to want to discuss their personal condition with a bunch of strangers online, are they?
Stafford will be chairing Day One of the 6th Annual Patient Relationship Marketing & Adherence Conference on 10-11 June 2009 in London. She will also be presenting learnings from the public sector, including how social marketing techniques are being used to encourage positive health behavior change.
For more information or to register for the Patient Relationship Marketing Summit,
9-10 June, 2009 in London, visit click here.
Di Stafford is founder and director of The Patient Practice a patient-centric marketing consultancy. She blogs for EyeforPharma here.