Did you take your medicine today? Simple question, simple answer. Or is it? 

Figures indicate that between 30% and 50% of medicines aren’t taken as intended, that up to 78% of patients do not adhere to their treatments, that unused drugs cost the NHS as much as £300 million every year, and that the US healthcare system could save $213 billion annually if medicines were used properly. And of course if patients don’t take their medicines the desired individual and economic outcomes won’t be seen – or as Mark Duman, non-executive director at the Patient Information Forum, says: “If patients aren’t taking them it doesn’t matter how good the medicine is.”

Indeed, with the new shift to an outcomes focus, outcomes-based measurement and medicines optimisation, there appears to be renewed vigour to tackle the thorny issue of drug compliance. But the problem, as Elisa del Galdo, head of customer experience at Blue Latitude, points out, is that “non-adherence is difficult to address with a single solution as there are a multitude of reasons why patients don’t follow their treatment regime as prescribed”.

Numerous initiatives sponsored by healthcare systems have been introduced recently to address the adherence issue, such as the Medicines Use Reviews in pharmacies, which has seen adherence rates pick up. Various competitions also focus on the issue, such as last year’s Small Business Research Initiative, which is currently evaluating innovative new products and services that aim to improve adherence, while the West Midlands Academic Health Science Network is calling for healthcare stakeholders to suggest solutions, models and technologies that address adherence challenges in the local health economy. Likewise, pharma has also introduced initiatives to provide additional products and services to support healthcare professionals and patients, from reformulations and new modes of action to patient information and digital applications. 

Indeed, both Duman and del Galdo believe pharma companies are now taking adherence more seriously, and have moved on from providing it as a bolt-on. “Services for ‘beyond the pill’ that can help patients to not only remember to take their medication, but also help them to understand their treatment at times when an HCP may not be available, or provide the motivation and behavioural change to make adherence a habit, are becoming more prevalent,” says del Galdo. 

But despite these efforts it is acknowledged that more work needs to be done. The adherence figures are something “healthcare systems and the pharmaceutical industry cannot ignore”, says a Lilly spokesperson. There is a clear gap between policy and practice in both the industry and healthcare system approach, says Duman. “Pharma may be investing in more serious adherence programmes but how will these be universally accessed? Both pharma and the healthcare system need to move away from pilots and work together to integrate a variety of adherence solutions into healthcare delivery – this is loosely akin to ensuring ‘user manuals/instructions’ accompany products,” he says. 

Understanding patient differences

Moreover, there has been a fundamental problem with the way the healthcare system and pharma have tended to treat patients as if they are all the same. Although this is changing, all parties need to continue to devote resources to understand why patients are non-adherent, rather than communicating to the entire patient population with one message, says Jonny Duder, managing director at Atlantis Healthcare UK. “Non-adherent behaviours cannot be properly addressed until the healthcare providers make a consistent effort to really understand patients’ individual differences and needs and, more importantly, work collaboratively with all stakeholders including drug and device manufacturers to create scalable solutions that support patients’ long-term needs and utilise proven behaviour change techniques,” he says.   

But determining the best approach is complex, says del Galdo, and it isn’t just about communicating the benefits of adherence. Any solution, she says, needs to consider the patient and the condition, the treatment, its adverse effects, efficacy, mode of action, mode of administration, reminder support but most importantly provide services, content and tools that influence and support behaviour change. To succeed requires a two-fold approach, she says. Firstly to understand the barriers to adherence and what would motivate a patient to be more diligent, and then secondly design solutions that overcome these barriers and encourage behaviour change. 

This approach ties in with the push towards increased patient centricity and the desire to understand and involve patients more. Pharma’s exploration of health psychology and behavioural economics to help unlock the answers on what makes patients tick and why they might not take their drugs is a step in the right direction, Duman believes. “Start by understanding the person. Then think of them as a patient, a condition, and a medicine. If you start from the product perspective then you’re back to sales.”

Technology is part of the solution

Fundamentally, though, adherence is about changing behaviours, says Duder, and the development of technology in the healthcare space is part of the solution. The rise in data analytics and wearables that can track and analyse behaviour as well as influence change is a game-changing milestone, he says. “The key to realising the potential of these advances is to understand how best to use the data they deliver to create interventions that help patients better self-manage their condition for enhanced quality of life.”

But as Duman warns, too much focus on technology and not enough on behaviour can be dangerous. Apps are a case in point. As they became popular there was a tendency for pharma to develop an app without thinking about the end game, says Duman. “There is a lot of focus on the power of mobile,” he says. “The channel is important but it’s more about being platform agnostic and offering users a range of ways to interact that suits their disposition.”

This is where wearable technology has helped by pulling monitoring, reminders and data sharing neatly together, and providing the opportunity to give patients a greater responsibility for adherence through a more tailored platform. “Ultimately, patients can benefit by utilising their personal data to learn more about their beliefs and responses to illness and treatment,” says Duder. “And by understanding their own behaviours better patients can overcome many of the barriers to adherence.”

But patients also need to be involved in the process and provided with patient-ready information, says Dr Geeta Hitch, lecturer in pharmaceutics and pharmaceutical chemistry at the University of Reading. “If patients were involved in the prescribing of their medication, and allowed to make informed decisions about their medicines, adherence to medicines would certainly increase. Patients would also develop a sense of trust and a better relationship with their HCP leading to increased adherence overall.” And as del Galdo notes, research has shown that the vast majority of patients are keen to be a partner. 

This is why a patient-centred approach to healthcare is crucial in tackling adherence, adds Lucy Chatwin, head of programmes for the West Midlands Academic Health Science Network. To better understand the problem “it is necessary to have an open, no blame approach that encourages patients to discuss any concerns about the treatment”. But equally this shows why healthcare systems and pharma need to work together as a team to meet patients’ needs. 

Adherence won’t be solved overnight but incorporating all stakeholders and moving down a more personalised path will go some way to ensuring the drugs are not only taken, but also work. 

Apps to aid adherence 

Care4Today Mobile Health Manager by Janssen Healthcare Innovation 

The mobile app and website triggers medication dosing and repeat prescription reminders and gives family members and carers the opportunity to provide support through a digital network. It also has built-in reports that track when and how medicines are taken over a period of time, which can be shared with HCPs. 

Turbu+ by Exco InTouch and AstraZeneca

This is an app for patients diagnosed with chronic obstructive pulmonary disease or asthma who use TurboPlus hardware, and is designed to enhance self-management. The service is an electronic data capture system that generates reminders and provides real-time feedback on their actual medication adherence. 

WellB by Bristol-Myers Squibb

Designed for patients diagnosed with hepatitis B and prescribed Baraclude, this app provides information on the disease and treatment to support medication compliance.

eMedsMate – medicine reminder by Techtree IT Systems 

This companion app helps patients manage their medicines and sends reminders, tracks medicines compliance and any side effects. The app also maintains records of health statistics such as blood pressure, blood sugar levels and weight. All information can be shared with relatives and HCPs. 

MedAdhIR by Ted Hancock

An adaptation of the validated Medication Adherence Individual Review Screening Tool, this app generates a series of questions to generate a risk score. If this falls under the level of certain criteria the app recommends the user receive a comprehensive medication adherence assessment from a senior care pharmacist.

This article was published in the March issue of PharmaTimes Magazine. You can read the full magazine online here