One Size Does Not Fit All
By Susan Stinson |
Q: There are some factors that have traditionally been the focus of adherence programs: affordability, side effects and complex dosing or administration. What other influencing factors now being addressed to help patients stay on their prescribed therapies?
A: The overall movement of patient adherence programs is toward a model that focuses on elements that extend beyond the product itself. While affordability, side effect profile and other product-specific factors continue to be important, we also see that a myriad of person-specific factors play a significant role in how adherent a patient might be. These factors include the patient’s overall health literacy, their ability to get to treatment sites on a regular basis, understanding of the severity of their condition. So, there’s broader recognition that patient engagement is a broader and better term that accurately reflects all of these factors. But patient engagement isn’t just a patient issue. It’s also influenced by providers and their ability to build patient relationships effectively, as well as their understanding of complex drug regiments.
To address issues like these, the World Health Organization (WHO) recommended guidelines like text message reminders and adherence counseling. But, there remains a need to understand the relative importance of different barriers to adherence and engagement and use that information to create more targeted interventions. No patient wants to intentionally sabotage his or her own care. That is why it is crucial that experts be involved in care teams – from clinically coordinated specialty pharmacies to payer liaisons to patient support services teams – that can assist providers in determining which mix of factors is impeding a patient’s ability to stay on their treatment course.
Q: In terms of specific disease class or drug categories, are some more prone to poor adherence than others? How are patient engagement programs tailored to meet the specific needs of individual patients?
A: Patients afflicted by any condition are prone to disengagement during their journey. Each time, it comes down to the individual patient’s diagnosis and contributing factors, such as age, comorbid conditions and behavioral disposition to name a few. For example, a diabetic patient diagnosed with a comorbid condition—such as rheumatoid arthritis—has a different care plan and different barriers to adherence than a diabetic patient who has a paralyzing fear of needles. Therefore, patient engagement and adherence strategies change to accommodate specific patient needs.
This approach is very different from when patient engagement and adherence programs first became widely used. We’ve learned that treating all patients in the same manner, for the same disease state, is no longer the best approach for improving outcomes. Today, the patient lives at the center. As a result, we have several programs dedicated to understanding the patient journey and each individual patient’s unique needs so services can be tailored to fit.
Q: Patient engagement and adherence isn’t just something that manufacturers are driving. What are other stakeholders doing in this arena to effect meaningful change?
A: It’s important that all stakeholders align on behalf of a patient and with a patient-centric approach. Together, the industry is making progress towards this kind of collaboration, but there is still work to be done. A few of the areas where we’re seeing advancements include:
- Third-party vendors of adherence-related support programs offer access to virtual support communities for patients during all stages of their journey.
- Pharmacy Benefits Managers (PBMs) have historically focused on cost control, but today are growing more and more instrumental in helping patients with timely initiation of therapy and adherence to therapy.
- Specialty pharmacies provide the special dispensing, administration and management of medications that are complex and have high-touch requirements.2 Specialty pharmacies also coordinate with the patient and work hand-in-glove with hub services, like those provided at Lash Group, to ensure a medication makes it to patient’s home on-time and that support is delivered in line with each patient’s expectation.
- Community pharmacists’ medication prescription management services can monitor for potential drug interactions that might lead a patient to stop taking a medication. They offer copay assistance such as product-specific coupons to reduce costs, medication-specific clinical guidance and often get to know a patient more personally to make it easier for them to stay adherent.
- Specialty logistics partners have also emerged as a key stakeholder, working closely with patient support programs on coordination and patient navigation in emerging therapeutic areas, like cell and gene therapy and rare and orphan products.
- For patients on a clinical trial, clinical research organizations (CROs) are also vital sources of support. They make sure patients stay adherent, not only for the patients’ health, but also to prevent the delay of new drugs from gaining FDA approval. Through customized telephonic and in-home support, clinical research organizations and manufacturers can help patients stay on trial.