One of the most complex and challenging situations facing today’s pharmaceutical industry is patient medication adherence and compliance. This puzzling and multifaceted issue has been the subject of debate in the industry for many years, with various companies revamping strategies to encourage patients to better observe their medication schedules. However, patient adherence and compliance has proven to involve more than just the pharmaceutical companies developing the drugs. Many stakeholders need to actively participate in developing a solution.
A Critical Medical & Societal Challenge
The issue of patient compliance has been a work-in-progress for decades and it does not discriminate based on a disease area. Nonadherence to pharmacotherapy ranges from 13 percent to 93 percent, with an average rate of 40 percent, and the problem involves all ages and ethnicities of patients1. Nonadherence to pharmacotherapy regimens has been shown to decrease productivity and increase disease morbidity, doctor visits, admissions to nursing homes, and death.
Additionally, noncompliance places a huge burden on the nation’s economy and is a significant source of waste. Studies estimate that it costs the US health care system upwards of $300 billion annually in direct and indirect costs, and results in an average per-drug loss of close to 40 percent in potential sales for the pharmaceutical company2.
What factors lead to noncompliance?
The factors influencing an individual patient’s compliance with a proposed treatment include:
- The extent of information provided to patients about their diagnosis and treatment regimen,
- Patient knowledge about his/her illness
- Patient motivation to manage his/her illness, and
- Confidence in the post-treatment outcome
Although one may think that the severity of diseases would correlate with higher compliance rates, studies have shown that this is not the case. On a global basis, there are many factors associated with adherence:
- Demographic influences
- Psychological and social factors
- Health care provider and medical system aspects
- Disease and treatment related factors
Several studies have shown that ethnic minorities, individuals with low socioeconomic status, and those with low levels of education have been associated with lower regimen adherence and greater chronic-illness morbidity3,4,5. Psychological and social analysis indicates that patients adhere well when the treatment regimen makes sense to them, when it seems effective, and when they believe the benefits exceed the costs. A key element lies in the education of the patient regarding the medication and the communication of guidelines, potential side effects, and likely results. In addition, the quality of the doctor-patient relationship is an important determinant of regimen adherence. Research in the field of diabetes has demonstrated that patients who are satisfied with their relationship with their health care provider (HCP) demonstrate better adherence. Finally, in a social context, studies have shown that low levels of conflict between patient, HCP, and prescription service; high levels of cohesion, organization, and processes; and good communication patterns are associated with better regimen adherence.
What is the pharmaceutical industry doing about it?
Since pharmaceutical companies are the drug manufacturers, it is in their best interests to be at the forefront of this battle to increase patient compliance. Due to the impact noncompliance has on both the health of the patient and the viability of the pharmaceutical company, there have been many programs and collaborations in the industry to create a more interconnected approach towards tackling this problem.
- Smart Pills: Pills with embedded ingestible sensors tracking medication adherence – Novartis and Proteus Biomedical.
- Patient Support Applications: Interactive games and applications for breast cancer patients to provide lifestyle tips, and treatment support such as connections with physicians and breast cancer communities– Genentech/Roche, Jelly Jam- 4HER Patient App.
- Smart Tech: An inhaler that records the date and time of every use for COPD patient adherence – Novartis and Qualcomm.
- Incentivizing Patients: Encouraging patients to document their prescription refills by rewarding them with gift cards or charitable donations – Novo Nordisk and HealthPrize.
- Educational Programs: Patients receive emails to educate them on the disease, and why it’s necessary to take the therapy – Biogen.
- Clinical Trial Intelligence: The ID-Cap includes a capsule with an embedded, ingestible wireless sensor and a wrist watch style reader. Each dose of medication is placed into an ID-Cap capsule, which emits a low power digital wireless message to the wrist watch after ingestion. The digital wireless message is then forwarded through the mobile web to the patient’s personal adherence record. Adherence information can be used by patients, health care providers, payers, and clinical trial sponsors to monitor and improve medication compliance – eTect.
Looking towards the future
As humans live longer, the likelihood of illness and disease will increase. This shift will result in more and more prescriptions being administered. The pharmaceutical industry must anticipate issues with adherence early in the development stage, and engage stakeholders to properly assess and create solutions that will be conducive to patient compliance. The outcome is healthier patients, enhanced patient satisfaction, and improved bottom lines for pharmaceutical companies.
Neha Suri is Senior Director of Life Sciences; Karl Varkey is an Analyst of Health + Life Sciences Practice for Fuld + Company .
- Gloria NE, Sylvie P. Optimizing Adherence to Pharmaceutical Care Plans. J Am Pharm Assoc. 40(4):475-485, 2000.
- Murray A. Avoidable Costs in U.S. Healthcare. IMS Institute for Healthcare Informatics. June 2013.
- Golin CE et al. A prospective study of predictors of adherence to combination antiretroviral medication. J Gen Intern Med. 2002 Oct; 17(10):756-65.
- Kleeberger CA et al. Determinants of heterogeneous adherence to HIV-antiretroviral therapies in the Multicenter AIDS Cohort Study. J Acquir Immune Defic Syndr. 2001 Jan 1; 26(1):82-92.
- Delamater AM et al. Psychosocial therapies in diabetes: report of the Psychosocial Therapies Working Group. Diabetes Care. 2001;24(7):1286-1292