PharmExec Blog

Changing the DNA of Pharma Patient Adherence Programs

by Grant Corbett

Epigenetics is the study of changes in human gene expression, in particular from environmental factors.  Pharma is also experiencing epigenetic change.  Human genes are formed from DNA, which are instructions much like a blueprint.  Similarly, the environment is changing pharmaceutical DNA and how brand marketing is instructed.

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For example, pharma’s genetic dependence on traditional blueprints (and standard agency recipes), targeting revenue from new molecules in the pipeline, is no longer sufficient for survival.  The environment has limited the availability of new blockbuster brands.

Similarly, the environment is changing the DNA of our belief systems. Here I am speaking of the evidence for effectiveness of patient medication adherence interventions.  How is this changing the DNA of brand marketing?

For more than a decade, we have believed that medication non-adherence was the result of patient knowledge and capabilities.  This has driven marketing focused on “patient education”, “segmentation” to identify profiles of patients based on their “barriers” (or “deficits”) and “tailoring” to help customize needed changes in the foregoing.

We have assumed that patient knowledge, of their disease and treatment, and their health literacy capabilities, for example, are critical to patient adherence.

However, the evidence now tells us that our assumptions were wrong.  More than 100 published studies show no correlation between a patient’s level of knowledge of their disease and treatment, and medication adherence.  How many valid studies show a correlation?  None of which I am aware.  Studies have shown that patient knowledge can be increased, but no increase in medication adherence has resulted.

Similarly, recent systematic reviews show no evidence that health literacy is associated with medication adherence in adult or pediatric populations.  As one of these review papers summarizes:

“A critical element of successful self-management is medication adherence. On this front, the evidence has been mixed. Although patients with limited literacy have more trouble understanding primary and precautionary medication label instructions and are less likely to be able to report the name of their medication, there is no consistent finding of worse medication adherence among patients with limited literacy.”

In fact, there is evidence that patients with “adequate health literacy are more inclined to purposefully not adhere to their discharge instructions.”

Do health literacy interventions improve adherence?  A 2011 systematic review found no evidence.

What about the promotion of health literacy programs?  Again, a 2011 review reports:

“…current research on health promotion for participants with low health literacy provides insufficient information to conclude whether interventions for health literacy can attract the target population, achieve an effect that is sustainable, or be generalized outside of clinical settings.”

“Tailoring” messaging based on patient characteristics has been a proposed as a solution to patient barriers.  However, a 2012 review paper, on the efficacy of tailored interventions for self-management outcomes of type 2 diabetes, hypertension or heart disease, concluded:

“Tailored interventions had no impact on self-management activities such as medication adherence, self-monitoring, exercise, smoking, or diet control.”

So, there is no peer-reviewed evidence to support developing pharma marketing strategy or tactics based on these assumptions of patient deficits.  Money spent in interventions based on these beliefs will produce limited or no ROI, as industry cost-effectiveness evaluations show.

What does the evidence, both academic and industry, show improves medication adherence?  This will be part of what you will hear at the Keynote Panel Discussion at CBI’s Patient Adherence and Support Summit (PASS) on Monday, April 29th in Philadelphia.  I look forward to seeing you there.

Grant Corbett is principal at Behavior Change Solutions, Inc. He can be reached at grant.corbett@behavior-change-solutions.com.

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3 Comments

  1. Posted March 14, 2013 at 9:21 am | Permalink

    Increasingly, we are understanding that medication non-adherence is largely a problem of human psychology, and less so a problem of cost, forgetfulness, or even education. The underlying issue is our natural human “present bias,” or preference for short-term rewards over long-term rewards. There are no short-term rewards inherent in taking most chronic meds. We need to build those rewards in.

    It’s the same problem that leads many of us to fail to save enough for retirement. It’s hard to put money away now if the payoff is years or even decades in the future.

  2. Posted March 15, 2013 at 11:55 am | Permalink

    Medication non-adherence goes beyond cost and knowledge. Patients feel the “pain” (e.g. side effects, inconvenience, etc.) of taking chronic medications now, but have trouble seeing the future rewards. If the current “pain” can be eliminated or reduced, adherence can be improved. This has been shown with adherence to anti-coagulation therapy (blood thinners). If the hassle of nuisance bleeding from minor cuts can be better managed, adherence to therapy can be improved.

  3. Posted April 7, 2013 at 4:27 pm | Permalink

    Agree with the above.

    Without providing the user an immediate “return on investment” (for buying and taking the medication), lasting behavior modification is unlikely to occur.

    However, quid pro quo (you do what I want therefore I reward you) is inherently negative reinforcement, flying in the face of rational self-determination. Stop paying someone to take medicine and sure enough, they won’t take it anymore, research has shown. Respect the user and capture their imagination, you might just have a chance.

    We’re taking the now oversold concept of gamification and putting it on “steroids,” giving users a way to win very high value prizes simply by responding to reminders (for medication, exercise and glucose monitoring). As such, we seek to habituate the desired behavior (adherence) rather than demand it. At the same time, we can completely subsidize the program, drive revenues for our retail and Pharma clients and boost star ratings. All of this is possible with web enabled interactive mobile. Exciting times!

    See you at the summit.

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