Could HCPs Hold The Key To Adherence?
The connection between a HCP and a patient is profound. How can it be harnessed?
Poor adherence hamstrings everyone in the healthcare system. It negatively impacts patient outcomes, costs healthcare systems billions in waste, and reduces the value of pharmaceutical products.
The statistics are sobering. In America, nonadherence has been linked to 30-50% of treatment failures and 125,000 deaths each year, according to the American College of Preventive Medicine.
“In the UK, unused prescriptions cost the NHS over £500 million per year. £500 million would get the NHS many extra nurses or mean that thousands of additional operations could be carried out or the best cancer treatments made available,” says Kumaran Krishnan, Associate Director, MSL and Digital Transformation, Teva.
There is a beacon of hope, however. Changing HCPs attitudes has the potential to vastly improve adherence. Pharma could help a lot in this space and it should — its future depends on it.
How? By hammering home the severity of the situation to HCPs, says Kumaran Krishnan, Associate Director, MSL and Digital Transformation, Teva.
“We need to educate HCPs because, on one side, they are treating the patient but on the other side they are not exercising control over the medication being prescribed.”
Educate, empower, initiate
Apart from shock tactics, All HCPs – physicians, pharmacists and nurses – need to be trained to pick up anomalies in prescription patterns, says Krishnan.
“If a patient fails to pick up their next prescription at the right time, there needs to be an investigation into whether they are taking their medication the proper way – bring them into the pharmacy or the surgery and make it clear that not taking the medication equates to a certain loss of function or not feeling better or long-term more serious health consequences for them .”
Incorporating topics such as medication misuse into medical education will support these efforts, as will regularly reminding people that increased adherence equals better outcomes, he says.
Ongoing and targeted patient education is essential, says Krishnan. “We are all patients. I don’t see myself as a clinician when I take a pill; I do miss doses, I do sometimes miss my insulin injections. If I am doing this as a clinician, how can I expect ordinary patients to understand this and do it properly? Patient education thus, is extremely important.”
For Laurie Myers, Global Health Literacy Director at Merck, educating both patients and HCPs is the “two-sided nature of adherence”.
“It’s not just the responsibility of the person taking a medication to know what to do, it is also the responsibility of the person doing the communication. Often, when providers communicate with patients, they ask if they have any questions and assume they understand. Health literacy is a global problem; people often struggle with health information, even if they have good general literacy.”
A new diagnosis can be overwhelming for anyone, she says. “They may be in a very difficult place with their emotions. We know that people forget a lot of what they hear when they leave the doctor’s office.”
Someone with low health literacy may feel intimidated to ask a doctor questions about their medication. Empowering patients by allowing them to engage in shared decision-making will improve the conversations between HCPs and their patients, says Myers.
Progress is afoot
Technology has lent a helping massive helping hand to adherence in recent years. Wearable devices linked to mobile apps, accessible by both patient and physician, can monitor disease and so aid medication adherence in diseases like diabetes, explains Krishnan.
‘Adherence packaging’ is a tiny device embedded in a pill strip or the cap of a bottle that can register the time and date every time a patient opens the bottle or pierces the strip. Again, the data is accessible to both patients and HCPs.
With a strong focus on respiratory disease, Teva is developing ‘connected’ or ‘smart’ inhalers to help patients improve their use and so reduce their reliance on rescue medication.
Technology only goes so far, however. Krishnan believes 70-80 per cent of the adherence problem is linked to behavior change. “We need to train doctors, pharmacists and nurses to empathize with patients, and to deeper understand the root cause of a patient not taking their medication properly.
Sharpen your social skills
There are some simple tools that healthcare providers can use in order to enhance their interactions with patients, says Myers.
One of these is the notion of universal health literacy precautions, where HCPs must assume that everyone will struggle with health information and communicate clearly and simply. “Even if you have someone in front of you with a PhD in biology, if they are newly diagnosed with diabetes, don’t assume that they will understand,” she says.
Another tool that can be employed is the ‘teach-back’ or ‘show me’ method, which shifts the burden of communication from the patient to the provider.
“An HCP might say, ‘Do you have any questions?’ and often patients will respond ‘No’. Instead, the provider can ask the question in a different way. They can ask the patient, ‘What will you go home and say to your partner or daughter?’ or, simply, ‘Tell me how you will take this medication’. If their answer is not correct, the HCP can address it immediately before it becomes a problem,” says Myers.
A common practice that is particularly helpful with non-adherence in polypharmacy, is the ‘brown-bag” method’. Here, the patient brings all their medication to the HCP, who goes through it with them.
“They can ask the patient: ‘What are you taking, what are you taking it for and how are you taking it?’ This allows them to immediately recognize if there are errors in how a patient is taking their medicine,” she says.
While such techniques involve specific communication skills, they are not difficult to learn.
Merck has produced educational videos for HCPs on both teach-back and universal health literacy precautions, using evidence-based best practices in the field. It also provides resources for healthcare providers on health literacy and healthcare disparities.
“We’ve had these resources for many years and they are not product-specific. Every doctor, nurse, and office staff, can benefit from being more aware of health literacy.”
Myers’ believes that health literacy is a pressing issue, and that pharma can help to raise awareness with HCPs. “The benefits of your innovation are only fully realized if your patients take their medicine as intended. Communication is part of the cure.”
Addressing non-adherence must remain a priority for the industry, concludes Krishnan. “Not just from a cost perspective, but also from a true ethical standpoint, we provide and manufacture medications and interventions to improve people’s health. Profit is of course important, but the true goal is to improve people’s health and how can we truly stick to that philosophy and enable our patients and HCPs to do that.”
Laurie Myers will be joining a host of thought leaders at the Patient Summit USA 2018 event in October.
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