Improving Patients’ Adherence to Medication Through Collaboration and Education
One of the greatest concerns encountered by the pharma industry worldwide is that of patients’ adherence to taking their medication, which healthcare professionals have come to understand is due to a distinct shortcoming in ways of educating the public and raising awareness.
To add some weight to the argument, and because it’s a disease that affects people and their loved ones in equal measures worldwide, diabetes has been chosen as a case study to help put this issue into context.
THE FACTS
Throughout numerous investigations and surveys such as the DAWN2 initiative (which will be discussed in greater detail) some alarming factors have come to light:
- Approximately 50% of diabetes patients are non-adherent when it comes to taking medication
- The biggest problems with diabetes management is the lack of appropriate education
- One of the many difficulties facing type 1 diabetics is calculating dosage
- Families are directly affected due to fear for their loved ones, negative financial impacts, community discrimination and unawareness of appropriate education programmes
- Patients, and in many cases their immediate families on whom they depend on, are uncertain about the implications of the illness
- Adherent patients can save the international healthcare system millions and millions of dollars, euros and pounds each year simply by taking their medication correctly
- Diabetic Patients and their families provide 95% of their care themselves
- Diabetes management is associated with provider-patient relationship and social support (i.e. active involvement of family members, friends and significant others)
- Non-adherence leads to a reduction in treatment, extra visits to the doctor and unnecessary hospitalisation creating higher costs in the long run
- Advice from healthcare professionals don’t always use the full base of knowledge about treating diabetes
- Diabetes, if untreated, could lead to neuropathy, nephropathy, retinopathy, hyperlipidemia and diabetic foot ulcers to name but a few
All in all a very grim picture has emerged and the important question is what (with a specific reference to the pharma industry) can be done about it.
Adding credibility to the topic, this reporter decided to call upon those who have plenty of answers, namely Dr. Katharine Barnard, chartered health psychologist who specialises in the psychosocial impact and management of diabetes, and Dr Neil Munro, associate specialist in diabetes at the Chelsea and Westminster Hospital, London.
Together they shed light on the situation by delving into greater detail and offering some invaluable suggestions. Healthcare workers take note.
WORKING IN UNISION
According to Dr.Barnard the most important contribution the pharma industry can make to improve patients’ adherence to medication and self-management is to improve collaboration with general practitioners, physicians and all other healthcare experts, not only throughout the UK but across the globe.
In doing so this umbrella of professional bodies will ensure that they provide the best possible support and that they critically examine the types of education that are required, as well as the context of the setting in which they take place.
“Some of the common problems in relation to diabetes management are around appropriate education both for the person living with the condition and also for family members,” explains Barnard, “In terms of the pharmaceutical industry, what they can do is to assess the ways they provide diabetes care in that regard. Many pharmaceutical companies actually already do provide diabetes education around the world to ensure people have suitable access so they appropriately self-manage their condition.”
In terms of other major concerns such as calculating dosage, Barnard places great emphasis on Bolus advisors, an innovative technology that has been developed by a number of pharmaceutical companies recently and is embedded within a standard blood glucose meter. The technology will enable an individual person’s medical data, set in collaboration with their clinical team, to be held.
The individual will inform the Bolus advisor the number of carbohydrates to be consumed in a meal by inputting this data into the blood glucose meter which in turn will advise how much insulin it recommends.
In 2011 NHS spending on diabetes was almost £10 billion, with a continued increase of type 2 diabetics. Barnard points out that to keep spiraling costs under control it is possible to educate people with diabetes and their families about how to best self-manage their condition. This will avoid the risk of these complications developing and hence keep costs down in all aspects.
POSITIVITY IS KEY
Dr. Munro too was also on hand to provide information on diabetic patients’ non-adherence to medication along with some of the consequences.
“The newspapers are full of very often negative press and that tends to interfere with people’s willingness to take their medication. Raising public awareness is key as far as improvement is concerned,” said Munro, “Early attention can prevent very long term complications and that is crucial because we still have a have a marked unawareness of the consequences of diabetes long term, particularly with regards to cardiovascular disease.”
Munro believes that some of the most significant contributions pharma can make to the problem are to become more involved in prevention programmes, namely those that deal with the early detection of diabetes, not just after the diabetes has been diagnosed, “sincerity at delivery of education throughout the continuum of diabetes will help considerably.”
As far as raising education and awareness in an attempt to overcome non-adherence is concerned, Munro highlights some examples, “People on the television who have diabetes such as characters in films, sitcoms or in regular programmes can bring things to light. People who are in public light who have conditions often bring it to people’s attention. In some countries health education programmes which are provided in the form of advertisements on television and on radio foster greater awareness and discussion about diabetes.”
THE DAWN2 INITIATIVE
DAWN2 (Diabetes Attitudes, Wishes and Needs 2), an expansion from DAWN conducted in 2001, is a global Novo Nordisk initiative working in collaboration with a number of affiliated organisations. It aims to raise awareness and self-management of the unmet needs of patients and their families, and ultimately stimulate improvements in the outcomes.
Munro believes the above initiative not only illustrates the current situation with statistics from extensive studies worldwide and raises awareness, but also reduces healthcare costs. It provides information about strategies that might work more effectively and illustrate gaps where professionals are already missing opportunities to intervene effectively on behalf of patients. Most importantly it explains that there is a general unawareness in the population of the significance of diabetes which must be brought home in as positive a way as possible so that it promotes healthier eating and more exercise.
THE SOCIAL ASPECT
Another issue worth consideration is the overall dynamic of a patient’s household. Thomas Belken and Neal Mozen wrote that understanding the dynamics of a patient’s household sheds light on non-adherence, as well as claiming that establishing a trusting relationship with the patient will go a long way to getting the patient to open up and trust the doctor and for that matter the pharmacist’s advice. Furthermore they believe that family and friends can reinforce the treatment protocol that doctors and pharma have set forth.
THE SOLUTION IN A NUTSHELL
Having garnered sage-like words of advice from the professionals a combination of the following will create a solution to the problem discussed
- Not just the pharma industry but also healthcare bodies worldwide can reduce non-adherence to medication by working in unison
- Establishing an earnest provider-patient relationship that will overcome patients’ disregard for their health
- Friends/families can reinforce adherence
- Raising awareness through innovative education programmes, which will help not only patients but their respective loved ones.
- Taking advantage of today’s medical technologies
- Continuously devise ways to reduce healthcare costs.
- Eating healthy and getting more exercise won’t hurt at all
Diabetes education programmes such as DAFNE (Dose Adjustment for Normal Eating, a training course), XPERT, DESMOND, Birmingham OwnHealth (a telephone-based information service) and the Buddy Service (a group of trained volunteers in Lothian who have personal experience of the life changes required to live with diabetes successfully) have received critical acclaim.
There is sufficient evidence therefore that the pharmacist’s role in caring for diabetic patients has grown substantially. The pharma role can educate diabetic patients about the correct use of their medication, monitor the patient’s blood glucose levels and keep records of it, explain monitoring devices, recommend the best products and services and even answer questions the patient didn’t ask the physician.
While the concept of diabetics’ non-adherence to medication (which is influenced by a plethora of factors as repeatedly emphasised) is nothing new, there are still large gaps of knowledge that programmes and surveys such as DAWN2 are continuously trying to close, and continuing collaboration from the wider healthcare community can make all the difference in future success.