Reframing the adherence challenge
Jennifer Sigaud, MD of Atlantis Healthcare, US,
says it’s time to think differently
IN my 20+ year career, there have been tremendous advancements in the world of healthcare, including new and better medications. Yet one problem continues to plague marketers, HCPs and other healthcare stakeholders: treatment adherence.
It’s the albatross of our industry, and doesn’t discriminate across conditions, populations or demographics.
There are many new, hi-tech ways to educate doctors, patients and caregivers – yet, remarkably, there is no straight line to ensuring patients follow prescribed treatment, whether it’s taking medication or also changing diet and other lifestyle factors or behaviors.
Why? Behavior change is hard. Everyone knows that a nutritious diet, regular exercise and a full night’s sleep are important aspects of a healthy lifestyle. Yet, how many of us struggle with these simple lifestyle changes? Just because we know some things are good for us, it doesn’t mean it’s easy to act on them. Did you get 8 hours of sleep last night?
There’s an opportunity to look at this differently. You can’t fix something unless you understand how it works. Likewise, you can’t change individual behaviors unless you understand what’s driving those behaviors. Health psychology allows us to look at the issues around adherence through a completely different lens, taking a step back to understand beliefs behind behaviors in order to design interventions that work to truly support each patient.
I’ve learned a few basic tenets from working with health psychologists around the world to develop successful treatment adherence and self-management programs:
1Education is not enough
If it were, adherence might not be as big of a problem. Many nonadherent individuals are intentionally not following their prescribed treatment. Health psychology frameworks give us the tools to understand the reasons why people are nonadherent, and to develop successful programs to address those individual barriers.
2One size can’t fit all
Just as we are all unique individuals, we also approach healthcare in personal ways. Two people with the same condition, on the same medication, will have different reasons for being nonadherent. Patient #1 may not like the side effects from her medication, and Patient #2 may think she doesn’t really need the pills because she feels fine. What good would a support message around side effects be for Patient #2? Adherence support needs to be personalized to resonate with each patient.
3Reminding isn’t always the answer
Since nonadherence is often an intentional behavior, health psychologists will tell you that reminders have limited success.
Even among those who truly do forget, once you take away the reminders, they can lapse back into old behaviors. Sustained improvements in self-management need interventions that drive fundamental changes in how an individual thinks about his/her condition and the prescribed treatment.
4It’s not only about the patient
Although every patient support program needs to be patient-centric, successful programs must also acknowledge the patient’s entire ecosystem.
For conditions like Alzheimer’s disease, caregivers must be supported to take care of their own health so they can be effective in providing care. Across any chronic condition, thought needs to be applied to extending the support across the patient’s world.
5Motivational interviewing isn’t the behavior change Holy Grail
I sigh every time I hear people equate “behavior change" with “motivational interviewing." The fact is that motivational interviewing is just one of dozens of behavior change techniques used by health psychologists. Just like one support program can’t be used to address all patient needs, one BCT might not be suitable for different patient populations.
Why should we care about treatment adherence?
The obvious answer is that we have to assume health outcomes will be better for patients who are adherent to their prescribed treatment. We hope their quality of life will improve as a result of their treatment. But there’s the financial factor also – how much is lost in medicines waste? How much will nonadherence continue to cost the healthcare system in hospital readmissions and complications from disease?
It’s time for a change. Pharma marketers need to walk away from old-school approaches to adherence, and embrace a smarter path that provides them with the insights and information to support patients and drive long-term change.
Jennifer Sigaud is Managing Director, Atlantis Healthcare, US. She has 20+ years of experience in healthcare education and communications, leading the development of strategic patient support and self-management initiatives that leverage patient and clinical insights.
Education is not enough. If it were, adherence wouldn’t be a problem.
