The evolution of patient adherence

There are some factors that have traditionally been the focus of adherence programs—issues like affordability, side effects and complex dosing or administration. But now, 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 and the understanding of the severity of their condition. So, there’s recognition that the definition of medication adherence has grown to reflect all of these factors. But medication adherence 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 to 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.

Meeting the specific needs of individual patients

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, adherence strategies should change to accommodate specific patient needs.

This approach is very different from when 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.

We also work with patients on the development of their individualized care plans, with specific check-ins that fit their therapeutic journey. Our approach ensures that we put forth the right resources and communicate in the right way at the right time—whether that’s telephonically, in-home, via text or other electronic channel. As part of this new approach, we have expanded our programs to leverage social workers, in addition to nurses and counselors, whose unique skill set is effective in coordinating and navigating all of these various touchpoints on behalf of their patients.

Everyone has a stake in adherence

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.

All of this tells us that there is no one-size-fits-all solution to patient engagement and adherence challenges, because every patient is different, each one has unique factors influencing their engagement and adherence, and there are so many clinical touch points along each patient’s journey. The industry is working to tackle the problem in many ways, and it will take collaboration and an ongoing personalized approach to help patients navigate toward improved health.

1. Ershad Sarabi R, Sadoughi F, Jamshidi Orak R, Bahaadinbeigy K. The Effectiveness of Mobile Phone Text Messaging in Improving Medication Adherence for Patients with Chronic Diseases: A Systematic Review. Iranian Red Crescent Medical Journal. 2016;18(5):e25183. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939231/pdf/ircmj-18-05-25183.pdf
2. The Management of Specialty Drugs. SPCMA, a Division of the Pharmaceutical Care Management rel="noopener noreferrer" Association, Feb. 2016, www.pcmanet.org/wp-content/uploads/2017/04/sPCMA_The_Management_of_Specialty_Drugs.pdf.