EVIDENCING PERFORMANCE ...
Script Your Future is a three-year commitment by NCL and its partners. What are your metrics and benchmarks for evaluating
progress of the campaign?
We are doing this several ways. Before the campaign launched in 2011 we conducted a baseline survey, nationally and in our
six target cities, to measure consumers' awareness of medication adherence as a health issue, and their adherence behaviors.
We will replicate that survey at the end of the campaign and compare the results. In addition, we are working with partners
who have access to pharmacy claims data to track takeup and refill trends in several of our target cities. In our surveys,
we found patients believe that the best way to increase adherence is automatic refillls, distribution of a "questions to ask"
your healthcare professional guide, reduced copays, and use of pill boxes.
GUS LITTLEFIELD, NATIONAL PRESIDENT, MENDED HEARTS:
We represent the patient community in the cardiovascular field. What I like about this campaign is its dual focus: you include
the caregiver as well as the patient. I am also encouraged by the commitment to create an inventory of best practices and
to work with the professional community to translate these into clinical guidelines. That is a very practical outcome that
I believe will lead to improvements in health status.
... DEPENDS ON HOW YOU DEFINE THE CHALLENGE
Good messaging depends on consensus around definitions. Given the multi-disciplinary nature of the NCL campaign, can we establish
what is most important in driving a solution to poor adherence? Is it strictly about patient engagement, is it an employer/productivity
challenge linked to disease prevention, or is it primarily about clinical awareness around the physician and the pharmacist?
LARRY BORESS, CEO, MIDWEST BUSINESS GROUP ON HEALTH:
Adherence has many moving parts. First is the appropriateness of the prescription itself and maximizing its clinical profile.
Second—and most important—is explaining to the patient why adherence matters to him or her. This is frequently never addressed
in the interaction with the physician. Here basic health literacy is a key differentiating factor in promoting adherence.
Our survey work buttresses this point over and over again. One example I can cite is when Hispanics with low facility in English
are given a prescription showing the drug is to be taken "once" (as in one pill a day), they can misinterpret this as the
Spanish number "eleven," and end up overdosing. Other issues include the failure of the dispensing pharmacy to ensure the
patient understands how and when to take the medication, as well as to inform families or other caregivers about the prescription
requirements and the competing economic priorities that the patient has to balance in managing those relationships.
ELYS ROBERTS, PRESIDENT, IPSOS HEALTH:
Whether other factors intervene or not, adherence is ultimately a personal issue. It's a unilateral action, and what determines
that action is unique to the individual. Hence, the objective of these adherence programs must be simple: What levers can
be pressed that will encourage more positive behavioral patterns? We have a presentation based on research we conducted with
1,200 patients called "The Curious Case of the Missing Prescription." It seeks to explain why a patient who voluntarily makes
an appointment to see a doctor to seek solutions to their healthcare needs does not follow the advice in taking any of the
medications prescribed. The disconnect has a psychology all its own and the roots are very personal. However, I believe the
solution is not a purely individual approach or a big standardized approach, but rather it requires you focus on specific
segments of the non-adherence community, at each stage of the adherence journey, and to prioritize attention to these groups
with a targeted plan.
COLLEEN MCHORNEY, SENIOR DIRECTOR, US OUTCOMES RESEARCH, MERCK:
We've done focus groups with more than 1,000 patients over the past few years to understand the roots of this problem. Merck
is using insights from this feedback to redefine the debate. Patients rarely talk about medication adherence, persistence,
or fulfillment, and they rarely raise the process around obtaining a prescription. What they talk about is the uncertainty
and ambivalence they feel about prescription medications. Research from UCLA and The Rand Corp. indicates that the average
physician spends only about 49 seconds informing patients about newly prescribed medications. Medication uncertainty—that's
how patients define the problem. There is a huge information deficit. Messages about the benefits of medications and the risks
of non-adherence are not getting through.