Uncommon commonalities: A patient-centric strategy for improving medication adherence
Understanding the factors that lead patients to abandon their treatment regimens is key to closing medication adherence gaps. Each patient experiences a unique set of barriers at different points throughout their treatment journey. An effective adherence program can help patients overcome struggles with side effects, access, finances, emotional distress and numerous other challenges.
In Part 1 of this series, Applying Behavioral Economics to Medication Adherence, we introduced using behavioral science as a foundation for designing effective medication adherence programs. A holistic, patient-centered support program requires considering a patient population's common link—irrational decision-making with regard to staying on therapy—along with the individual factors that impede adherence. The most innovative, effective patient support programs rely on three essential building blocks to address the multiple dimensions of non-adherence and transform outcomes:
1. Proactive identification of patient needs
To address medication adherence issues, tools that help identify and assess a patient-specific barriers to care are crucial. Through proactive needs assessment, predictive analytics, and segmentation, you can gain a more complete picture of the patient's journey and identify which patients are most at risk of non-adherence. Predictive analytics in particular can enable support program providers to proactively identify the needs of patients and engage them with support services before adherence becomes a critical problem.
For example, let's say a patient named Sally is enrolled in a manufacturer-sponsored adherence program, and we want to make sure that Sally doesn't drop off of her therapy. How do we know the best way to keep Sally engaged in managing her treatment regimen? The most advanced predictive analytics engines will aggregate claims data, eligibility information, demographics, and even data on previous interventions with Sally, correlating potentially thousands of data variables with adherence to assign an adherence risk measure that is specific to Sally.
From early identification of at-risk patients to customized interventions, early action is an essential element of a tech-enabled adherence program. In fact, using data analysis to segment patients based on different factors and to tailor supportive interventions can improve adherence levels by 10 to 15 percent.1
2. Meeting patients where they are
A truly patient-centered adherence program meets patients where they are—in their treatment journey and in life. An individualized care plan is the first step to addressing predicted adherence risks. Each patient care plan should include short-term goals to remove barriers and incorporate the individual's long-term goals, values, and sources of motivation.
Risk assessment, motivational interviewing, and other early identification of patient needs will reveal a great deal about the type of education and support that will best engage individual patients. The patient should then receive education, clinical support, and technological resources to empower them to effectively manage their own therapeutic outcomes. The overall objective of support program tools is to provide the necessary resources to help patients to adhere to prescribed therapies.
3. The right blend of high-tech and high-touch
As healthcare technology solutions continue to proliferate, personalized support and live outreach from nurse educators plays an essential role, providing the empathy and connection that patients need along their treatment journeys.
For optimal success, intervention strategies should incorporate the right blend of high-touch and high-tech to meet each patient's individual needs. While patient services should certainly leverage electronic communications to increase patient engagement via mobile applications, text messaging, live chat, or email, program sponsors shouldn't overlook the human element. Mobile technology, for example, enables the delivery of individualized content at the most appropriate time for a patient, but can a mobile device lend an empathetic ear?
Nurse educators play a critical role in providing support to patients. In fact, nursing services can improve adherence to prescribed therapies by 15 to 25 percent.2 And in patient outcomes literature, patients who receive personalized outreach have a 72 percent decreased risk of therapy discontinuation.3
A great example demonstrating the value that nurses play in adherence is a retrospective analysis measuring the impact of patient services on adherence conducted by AmerisourceBergen. The study evaluated 26,141 patients over a two-year period who were prescribed a biologic in the dermatology market
Through a patient partnership design, patients received assistance that was unique to both their treatment barriers and behaviors supporting treatment adherence. Through our care planning process, which starts with understanding what skills, behaviors, and knowledge patients have related to self-management, it was clear that patients commonly expressed similar barriers and behaviors to treatment. Our study population was split into two cohorts – those who enrolled in the support program and stayed for greater than 90 days and those who enrolled but unenrolled before 90 days.
It was clear that, behaviorally, patients struggle with very common problems – understanding administration technique, unsure about the duration and treatment regiment, and needing help to uncover the impacts to daily life (associated to motivation and belief). Within the patient related and condition related barrier groups, it was found that patients who unenrolled from the support program shared common barriers and ultimately needed more education about the condition and treatment plan, interventions to offset behaviors of forgetfulness or why they should be taking the medication.
Ultimately, the results showed that the patients who enrolled in the nursing support program and remained enrolled for at least three months were 1.9x greater to remain adherent to treatment and have shorter days (139 vs. 150) between fills. Demographic variables, use of a segmentation method, and identifying patient specific barriers proved to be significant predictors of having a medication possession ratio (MPR) above 80%. Patients achieving a MPR score of 80% or higher are considered adherent. There are so many unique aspects to building behaviors and skills for better treatment adherence at the patient level and this example highlights the importance of understanding where patients are in their journey.
Why nurses? These valuable members of the patient support program team often have both significant clinical experience in many therapeutic areas, as well as expertise in motivational interviewing and health coaching. They can use their clinical judgment to make appropriate decisions as it relates to coaching patients through a problem to ensure that, together, they're working through short-term and long-term goals to build the right skill, behavior change, or even the confidence to be able to maintain their care plan. Nurses also have a natural affinity for providing holistic support and problem solving skills that address the patient's needs beyond the pill in order to improve their therapeutic outcomes.
Transforming outcomes by digging deeper
Without a doubt, medication adherence is a cornerstone of improved health outcomes and lower healthcare costs. The most successful adherence services will incorporate both a proactive understanding of the factors that lead to non-adherence and a blend of high-tech and high-touch outreach to address those barriers, with nurses as a critical component of personalized support and live outreach. These elements can be transformative for a program—and for adherence at large.
1. Hichborn, Jason, et. al. Improving patient adherence through data-driven insights. December 2016. Accessed 11 June 2019. Available online at https://www.mckinsey.com/industries/pharmaceuticals-and-medical-products/our-insights/improving-patient-adherence-through-data-driven-insights.
2. Lash Group program data.
3. Marshall, John K. et al. Impact of the Adalimumab Patient Support Program's Care Coach Calls on Persistence and Adherence in Canada: An Observational Retrospective Cohort Study. Clinical Therapeutics. March 2018. Accessed 20 August 2019. Available online at https://www.clinicaltherapeutics.com/article/S0149-2918(18)30050-X/fulltext.
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