I agree that the doctor does play a role and that MOST patients don’t know all the details about why they should take their medication. This goes to my point about them stopping because they think the risks outweigh the benefits. If communication between doctor and patient were better perhaps this could be overcome in many cases.

Fact is that any solution has to address a number of points and interactions along the entire treatment continuum. One of the experts on compliance said it this way: “Mission Accomplished claims for a single compliance methodology should be held suspect.” (Check out the blog in the trackback in these comments to get some more details: http://www.doseofdigital.com/2008/12/glorified-alarm-clocks/#comment-11). He’s right on.

A lot more work to do.

Great article. I agree with you that adherence is a complicated issue with deep psychological roots and that a gadgety pill bottle may not be where the buck stops.

Technology does give companies an edge in segmenting high risk patients (meaning those who are not likely to adhere). However, I wonder if there is something can be done right in the exam room.

One of your assumptions is that patients know the risks of non-compliance. However, I don’t know if that is truly the case.

I read a lot of medical journals and it seems that the relationship of the patient and the doctor drives a lot of the patient’s healthcare decision-making. In many studies, clinicians are not clearly communicating risks and benefits. And we understand that–with reimbursements in the tank and the time pressures that come from an increasingly taxed system … well, how much can you really cover?

I’d like to see a two- or three-prong approach where the doctor clearly communicates the risks and benefits of the therapy and then reiterates that information in personal communications (the exam room) and also communicates via email or text, etc. For example, if a doctor could fwd an article or another patient’s story of success.

I’ve found that in my own personal experience (as both a marketing person and as a caregiver), it is the reiteration and the different ways of communicating on a single message can help 1) the news sink in, 2) drive the importance of adhering to treatment, and 3) continue keeping the importance freshly top of mind. And because I was at one pt a caregiver, I’d love to see more tactics that include friends and family of the patient — peer pressure can be used for good too

One way to help physicians better understand who is at high risk may be to create a statistical model by teasing out the X number of factors that indicate greater likelihood to be adherent versus not. Using this model, people could create a risk assessment tool… physicians could ask 3 to 5 key questions. Results would indicate who is high risk … and physicians could tailor their patient education accordingly.

As you said, this is a very complicated issue, but very important — particularly as we see the aging of boomers, the obesity trend, climate change, etc. driving more serious conditions in the population.

I’ve taken a lot of what I learned in my old job and what I’ve learned in my new job and got together with some really smart people here.

I think we have come up with something different that will make a difference in compliance. It combines tools to identify which users need the most help, which are likely to actually follow a program, how they prefer to receive messages including tone and channel, and all of it constantly evolving as the patient does. To add another layer, we’ve added in a social networking component as well. We found in our research that many caregivers want to help patients (and the patients want the help), but they don’t know what would be helpful. Our program helps define this including tools to discuss treatment, how to provide moral support, and practical tools such as schedulers to help patients, for example, on chemotherapy who might need help with chores or a patient with high blood pressure who needs an exercise partner.

We think it would be an amazing program, but someone’s got to take the leap. It would not be inexpensive to initiate, but it would quickly see returns if it works a well as I hope. I you want to know more, drop me a note.

I am on the look-out for something better and I will be following your future postings to see where you go with your social compliance approach. This is an area in desperate need of “re-imagining” of the problem and the solution.

Pharma has underwritten many of these solutions in the past (I know because I paid for similar solutions when I was a brand manager). Overall, the results were less than stellar. Some people it helped, but the vast majority it didn’t. Of those it did help, it didn’t last long because they didn’t make a wholesale psychological change, which is what is often required for long-term adherence.

So, Susan, how are these different from the reminder services and gadgets I critiqued in my post?

My solution is a patient-focused reminder software program called OnTimeRx. It was launched on the Internet in 2000 for the Palm and that now works on several platforms. We have loyal users all over the world who have been using it for years and say they “cannot live without this program”. They email me the minute they upgrade to a new device to get another key.

It works on Palm, PocketPC, and Windows Mobile hand held devices and smartphones, and on Windows XP and Vista PCs and as bundled combinations. A version for the BlackBerry is in development and should be launched soon.

We also have OnTimeRx automated phone, email and pager reminder services, but the software is the most detailed and full featured.

Big Pharma would be wise to consider underwriting some of these solutions, because they stand to benefit the most when patients stay on their drug regimens. The patient obviously benefits, too, in other ways that are harder to measure but are just as beneficial.

Free trials are available on all of these products. Check it out.

I’ll be outlining one solution our company is working on called “Social Compliance.” It combines a lot of the individualized messaging and segmentation that I mentioned along with the power of social networks to help open up people’s willingness to hear these messages. Still in development, but we hope it’s something that can be meaningful and will have an impact.