Compliance and concordance: Good for patients and for pharma
Peter Mansell explores how effective concordance can take the strain off industry-patient group partnerships.
By on Aug 23, 2010Peter Mansell explores how effective concordance can take the strain off industry-patient group partnerships.
Pharmaceutical companies and patient organizations are never going to be the easiest of fits.
It is not so much due to any fundamental unwillingness to work together, or lack of common ground, but rather to the kind of attention these relationships inevitably attract.
That attention may range from the suspicious to the downright hostile, whether it comes from regulators, budget holders, or a watchful media.
Yet patient groups can be an important component in market access strategy, putting a more human face on rigid pharmaco-economic assessments or rousing the same media to indignation when new therapies are denied coverage on cost-benefit grounds. (For more on patient groups, see How patient advocacy groups can boost patient compliance.)
Nonetheless, this very function is likely to come under closer scrutiny as governments and insurers raise the hurdles for long-term product value.
The specter of undue influence is hard to shake off, while rigorous demands for transparency in industry-patient group relationships may leave some companies wondering if it is worth jumping through all the legal hoops.
Against this backdrop, finding new ways of working collaboratively, and to mutual benefit, that do not carry the taint of industry lobbying by stealth is an urgent imperative.
One patient group that feels it is achieving these aims is the Dutch Asthma Foundation.
Taking money out of the equation
Michael Rutgers, director of the Foundation, recognizes there is a perception that alliances between industry and patient organizations have gone too far astray.
To avoid these image problems, he says, it is better to co-fund projects of relevance to both parties and with common aims rather than, for example, the patient group joining a project already conceived by industry.
The key, Rutgers says, is to take money out of the equation.
What these partnerships should not be, he stresses, is a tool for resolving competition within industry.
One area of clear mutual interest that lends itself well to less problematic collaborations is drug adherence and concordance.
Rutgers describes a project that the Asthma Foundation undertook in the Netherlands on a 50:50 funding basis with AstraZeneca (AZ), encouraging people with asthma in lower-income groups to make proper use of medical facilities.
The project was the Foundations idea and it invited AZ to participate.
The first step was just about creating awareness.
Disposable cameras were given to the target group, who were asked to take pictures of environmental factors they felt were having an influence on their asthma.
Subsequently, the Foundation and AZ sent in professional photographers and a booklet was produced for use in lobbying for improved living conditions.
The next step was to discuss how asthma could be affected on a broader scale, including the relevance of medical treatment.
None of this had anything to do with AZ therapies, Rutgers underlines: Were not interested in small differences between drugs.
Patient partnership and self-management
According to Rutgers, it is only recently that the full extent of the concordance problem with asthma in the Netherlands has emerged.
Whereas the old-fashioned approach was to leave the issue to the doctor, the emphasis is now shifting towards patient partnership and self-management.
Mostly, the problem is improper drug use or non-adherence.
Yet 51% of asthmatics in the Netherlands do not believe they are under-treating their condition, Rutgers points out.
The Asthma Foundation has been working on this project for around a year now, but it is very difficult to change behavior, Rutgers comments.
The Foundation already has partnerships with all of the pharmaceutical companies marketing respiratory drugs in the Netherlands, including AZ (tools to manage asthma), Pfizer and GlaxoSmithKline (both involved in a national project to increase self-diagnosis of chronic obstructive pulmonary disease).
In each case, Rutgers notes, the Foundation comes up with a project and looks for mutual funding from different sources, be they the pharmaceutical industry, insurance companies, or other stakeholders.
The aim is to deal with at least two partners per project, so that the funding can be spread.
Benefits to industry
With drug concordance, Rutgers observes, there is a benefit to industry beyond the kudos of being associated with a non-promotional health initiative.
If drugs are taken as directed, they will be seen as more efficient, which feeds into reimbursement, sales and profits.
In other words, Rutgers says, good concordance is good for patients, the healthcare system, insurance companies, and the pharmaceutical industry.
Not that it has all been plain sailing. With the AZ partnership, for example, there were many people in the company who wanted more of a promotional component, Rutgers notes.
But there are others who can see the rationale in moving away from the old behavior, challenging though that may be.
As Rutgers acknowledges, pharmaceutical companies do need to think about shareholder value.
That is why he emphasizes that carefully managed partnerships with groups like the Asthma Foundation are a win-win situation.
Better that, he adds, than the company pretending it is not in the business of making money.
In return, though, industry needs to recognize the experience and professionalism patient organizations have to offer.
Then those organizations can start to see the pharmaceutical industry not as a source of income but as a source of knowledge.