Adherence and patient support programs

Michael Clayton, director of strategy, Atlantis Healthcare Australia, on how patient support programs can connect patients with information and help them achieve behavioral change



While the recent controversy surrounding pharmacists being paid to enroll patients into support programs adds to a well-trodden path of bashing the pharmaceutical industry, it does little to address the astonishing fact that, according to the World Health Organization, half of all patients who are prescribed medicine fail to take their prescription as recommended. This well-entrenched issue is universal across disease states as diverse as cancer, cardiovascular disease, HIV, asthma and many others.

And while failure to take your anti-hypertensive or osteoporosis medication as prescribed may not seem like a big deal, it can lead to hospitalization for stroke, heart attack or hip fracture and the costs to the individual patient, society in general and the health system are immense. Non-adherence to medication has been estimated to cost $300 billion per annum in the US in avoidable medical spending. In Europe, non-adherence is a contributing factor in 200,000 deaths per annum and costs the economy €125 billion each year and is rising.

The old maxim that a pill doesn’t work unless the patient takes it is quite obvious, yet this has been a source of on-going frustration and mystery to healthcare practitioners for years; remember the rate of non-adherence is 50%.

Most of us would hope that pills prescribed for loved ones, designed to potentially extend or save their lives are taken correctly. But who is responsible for ensuring this actually happens? A visit to the doctor every two to three months doesn’t cut it and certainly isn’t working based on long-standing statistics; this level of support is simply not enough to improve adherence rates.

There is abundant clinical literature and evidence regarding rates of non-adherence, and many proven interventions have been successfully designed to address the issue. Professor Keith Petrie, head of health psychology at Auckland’s School of Psychological Medicine, cites research suggesting that 70 per cent of non-adherence is intentional.  The reasons why people deliberately choose not to take their medication are complex and personal, encompassing an individual’s beliefs about their illness and treatment.

However, simple examples of ‘reasons’ for not taking pills from patients themselves can include “The Internet said...”, “It reminds me I am sick”, “I don’t have any symptoms”.

This highlights a simple dilemma: Many life-threatening conditions are asymptomatic, such as high blood pressure and high cholesterol, which is a de-motivating factor for a patient to adhere correctly to their medication. It’s no wonder patients take it upon themselves to self-manage and intentionally reduce their recommended medication regimen, thereby increasing their risk of a poor (and expensive) outcome.

Other medications are often prescribed to reduce symptoms and must be used long-term in order to achieve the intended results for patients. Asthma preventer treatment is a good example of this; however, recent data has shown that only 28% of asthma patients correctly take their preventative medication in Australia.

So what to do? Yes, current support programs are primarily funded by pharmaceutical companies. Who else is ready to fund them? Let’s not forget that support programs are primarily designed to connect patients with information around their condition that helps them to understand why their medication is important and address any concerns they may have, while assisting them to manage side effects. These programs also equip patients with realistic treatment expectations and tips for healthy lifestyle and behavioral change. Many are run by registered nurses with significant involvement from healthcare professionals and health psychologists. The bottom line is, support programs play an important role in the health sector.

Meanwhile, a requirement of the Therapeutics Goods Administration (TGA) is to ensure manufacturers Quality Use of Medicine (QUM) is upheld, including recommendations for patients to take their medication as prescribed. The TGA itself has a requirement to ensure QUM, yet recent regulatory changes by the TGA have prevented the long-standing practice of including patient enrolment forms within medicines packaging. This has previously proven to be the most successful method for enrolling patients and is the most direct way to ensure that only patients actually prescribed the medication receive support. Furthermore, this required no money to change hands.

Though GPs and specialists are in the best position to provide patients with access to support programs, it is a well-known fact that they are over-burdened with paper work and are desperately pressed for time, which can put patient enrolments onto the back burner. Not surprisingly, a patient support program cannot work if a patient isn’t on it.

The next best avenue to provide patients’ access to support is at the point of sale, when the medication is dispensed by a pharmacist. On the back of recent negative press coverage, which has presented it as a sales and marketing revenue tactic, it looks like this channel could also potentially dry up.

At Atlantis, we support hundreds of thousands of patients and receive letters of thanks from the individuals on our programs on a daily basis. Among many things, our clinical team, comprising of health psychologists and registered nurses, coach patients on how to self-inject to manage diabetes and osteoporosis, assist them in coping with diagnoses of cancer and MS and encourage them to persist with injections into their eyes to save their sight. Support for their families and carers (with patient consent) are also available. We work in partnership with healthcare professionals and complement the role of doctors while providing additional services such as SMS reminders and smart phone apps.

Giving patients access to the support they need is a concern that the wider healthcare industry must address before better population health outcomes can be realized. And let’s also not forget that improving medicines adherence saves the taxpayer countless millions of dollars.

Michael Clayton is director of strategy, Atlantis Healthcare Australia.

For more on patient adherence, join the sector’s other key players at Patient Adherence Europe on May 31-June 1, 2012 in London.

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