It’s no secret that medication non-adherence represents an enormous challenge for the healthcare ecosystem: drugs manufacturers, payers and, of course, patients.
Previous studies have non-adherence at fault for around 125,000 deaths in the US and 194,500 in the EU each year, as well as hundreds of billions of dollars in costs to providers. Pharma companies are also losing out, to the tune of nearly $650 billion annually, in lost revenues — a level of leakage they can ill afford in the ever tighter financial environment all firms are operating in.
It’s estimated that less than 50% of patients with long-term conditions remain adherent to their recommended treatment. The question is: Why? Why wouldn’t patients stick to a regime they know is in their long-term interests? To find the answer, we need to look to behavioral science to deconstruct the psychological foibles and barriers that make people act in ways that can seem irrational or self-defeating.
It may sound simple, but we need to remember that people are human beings first and foremost. No matter the cultural, legal or regulatory context, all humans follow fundamentally similar behavioral patterns. Following a diagnosis, every patient is on a personal emotional journey: they may be feeling frustration with their medication, fear of side effects, or “treatment fatigue” from perceived lack of progress. Equally, patients also have their own idiosyncratic set of beliefs, attitudes, routines and behaviors that are unique to them and determine how they respond to situations.
Patient Support Programs – The Digital Dimension
Armed with this insight, we can construct patient support programs (PSPs) that work with the grain of human nature and real-world behaviors.
Over the past 20 years, pharma has invested in developing PSPs, but they have been limited both in terms of efficiency and functionality. Generally call center-led programs, they are expensive to run, difficult to scale, lack the frequency and reach patients require, and are based on interventions at set intervals that are the same for every patient.
But digital technology has upended that paradigm. Patients now have access to a range of devices that provide continuous access to, and two-way exchange of, information. They enable increasing insight and engagement with our everyday routines and behaviors. What digital enhancements enable us to do is understand the patient context and provide the right support for them, in such a way that support can be personalized, relevant and context-aware.
More Than A Nudge
When designing support programs the aim is often to assist patients in forming healthy adherence habits around their treatment. This makes a lot of sense when research tells us that as much as 40% of our behavior on a given day is habitual. In other words, almost half of our day is effectively spent on autopilot.
There are over 200 behavioral biases, or “bottlenecks”, that affect how patients interact with a patient support program, and to overcome them, over 90 behavior change techniques that can help people build healthy habits and routines around their medication and treatment.
Typically, medication management apps leverage time-based reminders to “nudge” the patient when they’re due to take their medication, but these often don’t fit in with the patient’s lifestyle and so fail to stimulate longer-term habit formation.
We can also leverage “social norms” to deliver more effective messages. As social creatures, we care deeply about what other people think. Designing a support program that couples remote outpatient tech solutions with personal care teams is a layered technique is proven effective. Care teams can leverage real-time interventions using web portals associated with smart devices that capture data in real-time when they notice a patient not adhering to their prescription. This can play into the emotional factor for the patients especially if they have built rapport with the care teams. Another technique is comparing a patient’s behavior to that of their peers, highlighting that the patient is an outlier when not taking their medication as prescribed, or even suggesting that people they care about would disapprove of them missing a dose can all act as powerful motivators by appealing to deep human instinct.
The Data Dilemma
Of course, the move towards digitally-enhanced PSPs underlines the critical importance of data protection and consent. The scandal engulfing Facebook serves as a salient reminder of the bear-traps that await data controllers when it comes to the sensitive handling of people’s personal information.
But that shouldn’t make us pessimistic. In this regard, healthcare has a major advantage over most other industries: the benefit we provide to patients is, essentially, longer life; more time with family and loved ones. And there’s good evidence to show that patients are motivated by altruism, with 94% of respondents to a 2014 PatientsLikeMe survey reporting a willingness to share their data if it helps others with the same condition.
Handled with respect, the unprecedented level of contextual data patients can share is creating the possibility of applying behavioral science at scale, to offer personalized support across patient populations on the management of their condition. This offers the opportunity not only of better outcomes for patients, but should also be seen as one of the most impactful tools we have to show value, improve the efficiency of program delivery and provide the real-world evidence base that payers increasingly expect.