By Matt Phillion
Medication adherence is top of mind across the industry, with its impact both on patients and the organizations that treat them.
Professional services firm ZS recently conducted a survey analyzing benchmarks for more than 35 products across nine therapeutic categories, examining a range of common chronic conditions, and found:
- Pharmaceutical companies lose up to 50% of patients within just two months of initiation
- This number reached 70%–80% within six months
- Myriad factors affect medication adherence, including disease and treatment complexity, healthcare disparities, and available patient support
Albert Whangbo and Vaibhav Bansal are leaders of patient-level data and real-world evidence at ZS and dug deeper into the research’s insights.
“What we’re observing is a complex problem,” says Bansal. “The way a patient interacts with the healthcare system is through multiple touch points. Any of these touch points can prevent the patient from sufficiently staying on therapy, whether that touch point is patient driven (their education, communication, or the disease itself) or organization driven (in the experience they receive).”
The pharmacy can also support the patient in getting on—and staying on—the right intervention, as well as offer information on the medication or product.
“It’d be a mistake to put the blame on the patient’s shoulders,” says Whangbo. “There are so many different factors and stakeholders that are working together in ways that are sometimes difficult to unravel that lead to adherence challenges.”
ZS has shown, Whangbo says, that many factors contribute to patients dropping off their therapy—it’s not just down to patients themselves, but also to providers, pharmacies, payers, and the patient’s environment. “It’s this very complex and multidimensional problem, and it’s clear there’s no one stakeholder who has the power to fix the problem,” says Whangbo.
Most ZS clients come from the product side of the equation, trying to rectify suboptimal outcomes with their products. ZS looks for ways to directly impact those outcomes, be it financial assistance, additional education, training, or other services that can be wrapped around the product, but these interventions don’t necessarily address the other factors involved.
“If you want to take a serious pass at medication adherence, keep the stakeholder in mind,” says Bansal, and think about what each part of the care team can contribute. The pharmaceutical company can help the patient with education, use of digital platforms, and the like, while providers can also help educate the patient and, alongside the hospital, ensure the right patient experience when beginning a treatment. The pharmacy can clarify the side effects of a medication and supply other educational components.
“Additionally, there is the payer, whose role is more around providing support to their member patients,” says Bansal. “There are various groups—minorities and other ethnicities, as well as lower education groups or lower economic groups—who are not covered as well as they could be.”
“Of all the different stakeholders, the most important one is the patient,” says Whangbo. “If we’re going to try to influence behavior changes, it starts with fundamentally understanding the patient’s perspective and experience.”
Adopting novel treatments
Many challenges with medication adherence boil down to communication—both the content itself and who delivers it, Whangbo notes.
“Patients have a preference for who they trust and want to engage with when it comes to education and support,” he says. “It’s not the first instinct for patients to ask the pharmaceutical company to educate them. It’s the providers, family members, friends, patient advocacy groups, support groups. There’s opportunity for partnership there.”
These patients seek out trusted resources because they’re often very ill and juggling comorbidities, making medication adherence even more difficult.
“If you get closer to the sources patients trust and are willing to engage with,” you have a better shot of getting them to adhere to the medications necessary for treatment, Whangbo says.
Bansal brings up the adherence challenge when a medication or treatment starts to improve a patient’s health: “Something happens with confirmation bias,” he says. “The minute a chronic condition begins to feel better, adherence goes down.” Providers must remind patients that their condition is improving because of the continued course of therapy, not because of a single dose or point in time—so they need to keep adhering to their treatment.
Patients also struggle with adherence when they’re taking multiple medications at once. “Sometimes they are overwhelmed by so many medications,” says Bansal.
There are unique barriers on the physician side as well, Bansal notes. “Especially in areas like cancer and rare diseases, physicians have their own constraints and barriers,” he says. “They may not have exposure to the latest developments, and push back to more known, proven therapies instead of the latest technologies and products.”
Nurses and office staff are oft-overlooked stakeholders in this equation, Bansal says. “Once the physician authorizes the prescription, a lot of the interaction happens with those other roles,” he says. “Especially during COVID, we are seeing nurses looking for more support on how to manage the patient.”
By giving these team members more product information, guidelines, expected results from a treatment, and other education, care teams can move one step closer to better medication adherence. “We’re seeing progress in that direction,” says Whangbo. “In the last five or 10 years, there’s been more realization that these roles in the treatment journey are critical, and how important it is to dedicate resources to provide support, and education where it was previously physician focused.”
Payers, meanwhile, may not be as focused on adherence, Whangbo notes. They tend to be more focused on solving a health problem, as well as managing cost. Here, the right advocacy can demonstrate to payers how better education can help make patients more adherent.
Listening to the voice of the patient
“Within our firm, we spend a lot of time on analytics, and there [are] real benefits these stakeholders can get from these drivers,” says Whangbo. “But we have to listen to the voice of the patient to understand what they’re going through and what makes their lives better.” Ultimately, Whangbo notes, this helps uncover the incentives they need to improve treatment adherence.
“There are a lot of implications for the need to be more patient centric, even upstream with product development,” says Whangbo. “One of the drivers of poor adherence is that it’s all not patient friendly—if I have to take four horse pills a day, no one’s going to want to do that. Or drive 50 miles to get my next injection. We shouldn’t be surprised adherence is low.”
Sometimes science hasn’t advanced enough to make treatments more patient friendly, but other times the problem is just not being aware of patient needs. “If there was more empathy to the patients, even at the clinical development stage, we’d have more treatments advancing through clinical development that are easier for patients to consume,” says Bansal. “That’s going to fundamentally improve the adherence picture.”
Bansal sees the industry progressing toward two areas in improving medication adherence. The first is changing the narrative.
“Pharma is slowly coming to terms that there is more that can be done in terms of understanding what is acting as a barrier to the patient, and developing an informed approach from barrier to action,” he says. “I see movement in that direction—it could be faster, but there’s movement.”
The second is acknowledging the patient as the most important stakeholder.
“We will move toward more heavily investing in providing platforms to further providing more support to patients,” Bansal says. “This also means delivering more resources for hospitals and providers—emotional support, access to experts—and in getting closer to the patient. Improving effectiveness in reaching patients but also knowing what the patient is looking for and providing custom content: That’s where more needs to happen.”
“My ideal state would be a real embrace of patient centricity,” says Whangbo. “Not just a buzzword or a checklist, but something that becomes core to the organization’s culture and how they define success.”
If the industry truly wants to embrace patient-centric care and improve medication adherence, it can’t take a tone-deaf approach with the aim of checking a box and moving on, Whangbo says. Rather, it needs to think about the patient experience, including addressing disparities in care and inclusivity. “You can ask patients to fill out a survey, but unless there’s actual follow-through, it’s just lip service,” says Whangbo.
This total approach to care may not specifically target adherence, but it has an impact down the line, Bansal says. “At the executive level, if [this approach is] focused on the patient, then adherence will show up as a benefit,” he says.
“We’re starting to see it,” says Whangbo. “There’s an increasing shift toward personalized medicine, because if we are tailoring therapeutics for patients, that addresses one of the big clinical barriers to adherence. If we’re more confident a treatment will work for you, the individual patient, we’ll see more adherence.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at firstname.lastname@example.org.