The issue of non-compliance, where a patient doesn't follow their prescription properly, is a big concern for both healthcare professionals (HCPs) and pharmaceutical companies. Clinical researchers estimate that for most drugs patient compliance rates are 50-60%, but with some conditions they drop as low as 10-20%.
Our experience in designing bespoke compliance program that mirror the patients' real-world experiences has shown that involving patients in the management of their condition has a considerable impact on their ability and desire to comply with their treatment and make lifestyle changes. Our research driven programs track the patient journey and identify the pivotal points where they require support and encouragement to help them remain compliant. This article aims to provide some insights into what makes a successful patient support program.
Understanding the patient
Every patient compliance/support program should start with a full understanding of the reasons why patients don’t adhere to their treatment. Qualitative patient research will provide valuable insights into what impact the condition has on the patients – physically and emotionally – and provide a deeper understanding of their lifestyles and when they’re most likely going to require support. Starting a compliance campaign with this backbone will ensure the delivery of the right message at the most appropriate time.
The decision on whether to conduct focus groups or individual depth interviews will depend on the stigma attached to the condition. For example, patients suffering from depression are unlikely to speak out in a focus group, whereas patients living with conditions such as hypertension or venous leg ulcers, can benefit from focus group dynamics.
Engaging with the field force
The pharmaceutical field force team plays a crucial role in ensuring the successful uptake of the patient compliance campaign among HCPs. Detail aids (both e-detail and printed formats) should be developed that enable the field force to guide the HCP through the program and explain the benefits for them and their patient.
Tools for the medical community
Patients are increasingly well informed and, while they will seek advice and guidance on medical treatment, a compliance program offered through the HCP that is involved in their treatment is more likely to be taken up than one the patient finds themself. A well designed and well managed patient compliance program should save HCPs’ time in handling general queries from patients and aid concordance.
Combined-focus interventions
‘Combined-focus’ patient interventions have been shown to be more successful than ‘single-focus’ ones. In fact, the most effective patient compliance campaigns incorporate a combination of educational, behavioral and affective communications, which educate patients about their illness and treatment, teach them behavioural strategies to enable them to cope better with symptoms and medication taking and address emotions and moods.
There are a series of techniques available to reach key stakeholders, and, depending on budget and audience, these could include:
• Direct mail
• Nurse-led support
• Digital communications
A typical compliance campaign should contain information that will educate, support and motivate the patient. Materials should be prepared in consultation with a KOL and/or patient group, and focus on the patient holistically. A basic program should include information on:
• Treatment: Understanding the condition, why they have been prescribed the medicine, common side effects and the consequences of not adhering.
• Diet: Impact a healthy diet will have on their well-being. Details of healthy foods, recipe plans, replacing ‘bad’ snacks with ‘good’ treats, etc.
• Exercise: Why and how often they should exercise, what types of exercise are suitable, how to stay motivated.
• Support: Advice on asking for emotional/practical support, other available support techniques, patient groups, etc.
Other materials that can be developed include treatment diaries (for patients to document their diet, exercise or emotions), motivational postcards and CD-ROMs with patient case studies and exercise techniques. Stickers for diaries/calendars are a good way of reminding patients to take their medication – particularly if their treatment isn’t daily. Key treatment messages can be reinforced through mailings at crucial points throughout the treatment regimen.
Personal contact
Patients respond best to personal contact and yet can feel intimidated by their HCP. However they do view nurses as being more approachable and having more time available to discuss their concerns. One of our most successful patient compliance programs utilized qualified health professionals to proactively contact patients with mental health conditions to provide information, advice and encouragement throughout the course of their treatment.
The use of technology
Datamonitor’s eHealth Insight Survey from 2005 revealed that patients have a strong interest in using technology-enabled services to facilitate their interaction with their physician. The survey showed that email communication with their physician and access to compliance tools were rated most highly.
The use of mobile devices such as PDAs, iPhones and Blackberries is growing, although adoption is relatively slow and often focused around business usage. Many patients have access to laptops and use them regularly to search for health related information. In this day of ‘always-available’ communications, mobile phones can also be incorporated into patient compliance programs.
E-mail and SMS messaging services are useful tools for reminders about refilling prescriptions, taking medication (particularly if the medicine is weekly or monthly) and for scheduled medical appointments. SMS messaging is particularly successful for younger audiences who are avid users of mobile technology, but is unlikely to reach the more senior age groups.
Web-based compliance programs are more attractive to patients who already spend more than ten hours a week online. These patients may also respond favorably to support provided through CD-ROMs. These mediums work well for personalized treatment diaries, downloadable information booklets, practical video clips from clinicians and they allow patients to incorporate more extensive questions and responses about the condition and treatment.
Win-win-win situation
Patient compliance campaigns that provide the key audiences with the most effective information at the most appropriate time create a win-win-win situation for everyone.
For more information on this topic, please contact the author, Carole North (carole.north@90ten.co.uk)at 90TEN Healthcare, www.90ten.co.uk
