Framework for Success
The buzzwords "targeted education" are reverberating throughout the healthcare industry as the best way to help patients stay
on their treatment. Kaiser Permanente, the biggest payer in California, recently received an innovation grant to create a
framework to systematically address nonadherence to avoid the trial-and-error methods that most pharma companies are implementing.
"They said, 'Okay, we will give you some money,'" Oyekan says. "'Go work with a team of people to come up with the tools to
put this concept into reality.' And so we went to work with that."
The Kaiser team created tools centered on a handbook titled "Be Smart" that was initially released for pharmacists and nurse
care managers. The book outlines the different types of barriers and how to assess whether or not a patient is even willing
to address these barriers, the different barriers, solutions, and the different resources within and outside of Kaiser Permanente.
"The next chapter deals with how to motivate a patient," Oyekan continues. "Here, we started talking about how companies must
look at a patient who is on medications—like a marathon runner. You just don't go out there one day and say, 'I'm running
a marathon' and you're successful at it."
The handbook outlines a litany of tools that can be used to get patients invested into their treatment, including: regular
e-mails, snail mailers, regular phone calls, meetings with care managers, and informational classes.
A big part of the program is also about understanding adherence around a particular treatment. Kaiser groups the different
medications it dispenses in the outpatient pharmacies by drug class, and then lists key topics associated with the treatments
that pharmacists can talk about with patients.
"So we can actually identify the patients who are nonadherent," Oyekan says. "We can give those patients to the provider,
and then the provider can use the 'Be Smart' methodology to identify what the issue is with the patient, give the solution,
and then triage them either to health education, to a care manager, to a pharmacist, and to the different other resources
that are available to the patient."
The big question that remains is how can a program like this be tailored to the individual patient? Much of the handbook includes
no-nonsense ways to proactively educate and inform, but shouldn't much of the conversation be common sense at this point?
According to IMS Health, there is no easy—or low-cost—solution.
IMS Health studied the results of 755 adherence programs (from 1972 to 2002) pertaining to cardiovascular medications—a disease
area that has a very poor level of compliance.
The study agreed with most of Kaiser's assumptions. "We found that the most effective approaches for improving adherence are
multifaceted," the authors stated. "Personalized, intensive interventions offered the greatest improvements in adherence,
as was found in our earlier study. However, these improvements in adherence with personalized intensive interventions must
be balanced against their higher costs."
And the clincher here is higher cost. A traditional pharmacist program where the patient has a one-on-one session to discuss
his or her treatment can cost upwards of $125 per patient. Compared to mailers that are sent out at random to everyone for
the cost of a postage stamp and a postcard, the cost is astronomical.
"By targeting intervention, pharma companies are making the programs more effective and less expensive, because they aren't
spending money on a lot of different tools to everyone," says Richard Chapman, principal, Health Economics & Outcomes Research,
IMS Health. "Much like personalized medicine, if we can really hone in on a subset of patients that are really going to benefit
from the different things, we can be much more effective in how we go after patients."
One partnership that appears to be working well is the collaboration between Pfizer and Walgreens. The two giants in their
respective industries created an informational program that allows the pharmacist to engage customers about their medication.
"We all know that the pharmacist can and should be playing a greater role in the whole healthcare system," says Adele Gulfo,
US president and general manager, primary care at Pfizer. "The pharmacist is an educated person at the point of [dispension]—that's
a very impactful point for a patient."
Pfizer and Walgreens launched an intervention-based program featuring behavioral counseling and education at the point where
a patient goes to pick up his or her medication.
"When you have motivated participants, pharmacists are going to go out of their way to ensure that the patient understands
their medicine and disease, and a more educated patient has a better shot at having a better outcome," Gulfo says.
This particular pilot program is only for Pfizer medicines, but the pharma giant would like to see it spread to other disease
"When you ask a patient, 'Why didn't you take that medicine?' by and large they will say that the physician didn't take the
time to explain what the medicine really does," Gulfo says. "The second missed opportunity comes when the pharmacist doesn't
explain it. That's where you get a lazy attitude on the part of the patient."
The Pfizer/Walgreens collaboration encourages the pharmacist to get out from behind the counter and engage the customer in
a conversation, allowing the patient to leave with a much more educated mindset about not only their medicine, but their disease
"We are not going to crack the code to adherence doing one intervention," Gulfo says. "Most times it's going to be multifactorial.
The most opportune time where we've seen increased adherence rates is if you educate and get that patient engaged at the start
of their medication program."