The Adherence Fight: A TKO? - Pharmaceutical Executive


The Adherence Fight: A TKO?

Pharmaceutical Executive

Round 4: Center for Business Intelligence

The Center for Business Intelligence (CBI) has long recognized the merits of direct intervention geared to the patient. It holds an annual conference and awards ceremony each April devoted entirely to coming up with innovative ways to tackle the problem.

The focus at the 2011 conference was on shaping patient behavior, says Christen Smith, program manager at CBI. "The best way to do that is to find the key points of intervention with the patients and train those people who are having the most influence with the patient to institute more practices to improve adherence."

One of the biggest potential influences, according to the speakers at the conference, is pharmacists. A great deal of emphasis is being put on the pharmacist/patient interaction, she says, "to get the patient to explain more about why they aren't picking up their prescriptions on time, or not at all, or if they're taking them incorrectly."

Like Blackwell, Smith and others at CBI recognize the value of collaboration when it comes to facing an opponent such as non-adherence. "There was quite a bit of talk at the conference on those different partnerships," she says.

Going forward, Smith says, changes in the industry—including healthcare reform—will change the way pharma and other stakeholders approach adherence. "With providers being incentivized to improve outcomes and not just continually treat patients [through ACOs, for example], physicians and managed care are going to have a greater stake in adherence. They're not exactly penalized, but they may make less money or get less reimbursed if they don't improve patient outcomes. And one way to really improve those outcomes is through better adherence."

Round 5: National Consumer's League

Also making a new play to drive better patient adherence is the National Consumer's League (NCL). In May, NCL joined with US Surgeon General Dr. Regina M. Benjamin to launch a public education campaign to raise awareness among patients about the consequences of not taking medication as directed.

The campaign, "Script Your Future," features a website that offers "tools to support patient efforts to adhere to their prescribed medication, including text massage reminders, medication charts and lists to keep track of medications, and fact sheets on common chronic conditions," according to a NCL press release. The campaign is supported by a coalition of close to 100 public and private partners and sponsors, including healthcare professional groups, chronic disease groups, health insurance plans, pharmaceutical companies, consumer groups, and government agencies.

Script Your Future is focusing on three common chronic conditions: diabetes, cardiovascular (which includes high blood pressure and high cholesterol), and respiratory (which includes asthma and COPD).

"One way we're approaching this, based on the research that we've done, is that patients don't always understand their condition, and they don't always understand the consequences of not taking their medication," says Rebecca Burkholder, vice president of health policy for the NCL. "We conducted focus groups across the country with patients that had these chronic conditions. And what seemed to be effective for them was focusing on the consequences, on the impact that not taking your medication can have on not just you, but your family. If you don't take your medication as directed, you might not be around for your family—to enjoy moments together or to help take care of them."

Over the next three years, the campaign will provide materials through partnerships with pharmacies, hospitals, medical offices and clinics, and health insurance plans; host community events and health fairs; and evaluate medication adherence awareness through research.

Local radio spots, public service announcements (PSAs), and online videos are also part of the campaign, along with a sister website designed for physicians and other healthcare professionals, "because we know it's really important that they are very much involved, having that conversation with patients about their condition and their medicine—that's key," says Burkholder.

Overall, she says, the campaign "is about raising awareness as a step toward changing behavior." Later this year, Pharm Exec will participate in a Round Table discussion with the NCL to further discuss the problems and possible solutions surrounding adherence.

A New Champion?

Going forward, if pharma and other stakeholders are to win the fight against non-adherence, new strategies must be employed. One critical driver is focus—targeting the message to a degree that was missing in the past.

"Companies come up with these cross-product platforms that address the issues related to adherence, and they expect them to work in diabetes, cancer, overactive bladder, multiple sclerosis, and all these other conditions," notes Vernon Schabert, senior principal in the Health and Economics Outcomes Research practice at IMS Consulting group, "when really, every single one of these therapeutic areas has different populations with different concerns, different symptoms, different cost burdens, and so on. And so it's really important when you're looking at adherence as a solution to say, 'What does it mean for this specific product and this specific therapy area?'"

With these cited new initiatives from NCL, Knowledge Clinic, and other concerned organizations and stakeholders around the world, it may just be possible for industry to score a momentum-shifting blow in the adherence fight. As the Capgemini white paper puts it: "Understanding of the issue has evolved from the narrow scope of compliance, which places the entire responsibility on a passive patient, to a broader definition where adherence is a more collective responsibility between healthcare providers and patients who are active participants in their own care."


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