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July 20, 2016 Linda Ruschau0

July2016-RuschauArtworkOne of the first health lessons many of us ever heard was that famous rhyme our mothers used to recite frequently: An apple a day keeps the doctor away. With all due respect to mothers everywhere, while apples are a perfectly good source of nutrition and have many benefits, unfortunately we know that simply eating one every day is not enough to keep us in perfect health.

However, if you’ll indulge me for just a minute, let’s pretend that apples really could keep the doctor away. Sadly, here’s what we know would happen:

  • Roughly one-third of people who are supposed to eat an apple a day wouldn’t even go to the grocery store to buy a bag[1]
  • 75% wouldn’t eat an apple all seven days of the week, but they’d definitely try their best to eat an apple at least four or five times per week[2]
  • More than 70% of those struggling with depression would start eating apples every day, but would no longer be eating them after six months[3]
  • The grocery industry would be spending hundreds of billions of dollars per year trying to figure out why nobody wants to eat their apples[4]

Unfortunately, as we all know, we’re not talking about apples. This is the reality of the pharmaceutical world, as study after study has shown that patient adherence and compliance are two of the biggest challenges facing the industry.

You can write this off as human nature if you want. After all, people are notoriously bad at taking orders and following directions. But what if the problem isn’t that patients don’t know what they are supposed to be doing, but rather, they simply don’t understand why they should be doing it?

As a brand marketer, there’s a huge opportunity for you to go beyond the prescription pad to give patients what they want most: knowledge.

By incorporating key messages in education materials placed in the offices and exam rooms where they receive this prescription, you can go beyond simply telling the patient what they should be doing. Rather, you are showing them why they should be doing it and empower them to ask questions that truly make a difference in their health journey.

What are those questions? Here are a few to get you started (using our “apple a day” example):

  • What do I need to know about this disease/condition?
  • Why is an apple a day the right treatment option for me?
  • How is the apple a day going to improve my disease/condition?
  • Do I want a red, green, or golden apple?
  • Are there any side effects to eating an apple a day?
  • In addition to the apple per day, what are other treatment options or things I should be doing to manage this disease/condition?

And it’s not just patients who find this information helpful. As Debra Miller, M.D., from the Mapleton Medical Center in Indiana told PatientPoint, “Staff and patients really love [your] brochures because it’s easy to get the information they need. Often, I walk into the exam room and the patient has already taken a brochure and has questions ready for me.”

By planting the seeds of knowledge before the script is ever written, you encourage a meaningful conversation between patients, staff and physicians about the disease and medication options. And while telling someone to eat an apple a day may result in temporary success, showing them why it’s an effective option can produce much more fruitful results.








July 20, 2016 admin3

The current statistics on medication adherence are remarkably somber. At the moment, lower rates of adherence translate not only into poor health outcomes which result in 125,000 deaths per year, but also healthcare costs ranging from $100 to $300 billion annually. Over the past 30 years, the WHO and Institute of Medicine (IOM) have not been able to achieve their goal of rate improvement. July2016-DiPersioArtwork1By addressing challenges associated with health beliefs, learning styles, medication regimens, and inherent changes in patient status, pharma will develop the necessary support system to increase rates. Mobile phone interventions, patient literature, and pharmacy in-person consultations are critical tools of a multi-channel approach to maximize medication adherence.

Mobile Phone Interventions

The simplest form of mobile technology which increases medication adherence is text messaging or short message system (SMS) that includes program details, therapy reminders, and motivational information. This inexpensive vehicle provides a consistent flow of enhanced daily patient communication. Targeted and personalized information is quickly and conveniently sent via mobile phone to the right people at the right time. An OptumRx study involving experimental subjects who received several different kinds of medication alerts, refills, and dosage reminders culminated in an overall medication adherence rate of 85% on the experimental side and only 77% adherence on the control side.

July2016-DiPersioArtwork2On the other hand, adherence rates are higher when using the most complex form of mobile technology that includes artificial intelligence-adapted text messages with reinforcement learning (RL). RL automatically modifies SMS communication to provide data which is tailored to current needs and also adapted to future needs as patient status changes. The customized algorithms “learn” from their interactions with patients to determine the appropriate action that optimizes total reinforcement and motivates behavioral changes. In a University of Michigan project, researchers created a RL algorithm for innovative decision making based specifically on hypertension medication bottle openings recorded via electronic medication monitoring. A database tracked patient feedback from the medication event by monitoring system cap openings and then a RL engine learned from patient experience to determine individualized messages to send at specific times.

Patient Literature

More than 95% of pharmacists believe patients who receive product-specific, easy-to-understand, and culturally relevant education brochures from the pharma industry, such as novelas with comic-book style images in the Hispanic culture, benefit from greater levels of medication adherence. However, the caveat is low literacy skills across all populations that often times result in a misunderstanding of prescription drug warning labels followed by an incorrect use of medications. The majority of prescription instruction sheets are written at a ninth grade level or above but almost 90 million Americans read below the fifth grade level.

However, patient literature is boundless in improving oral cancer drug adherence. Oral cancer medications are self-administered with patients taking charge of managing their own conditions. July2016-DiPersioArtwork3While perusing literature at their convenience during their own private time, patients not only educate themselves about their illness and the common side effects of oral chemotherapy but also develop the insight of when to seek emergency care. Literature motivates them to gain a better understanding of the condition and assume an active role in their treatment. The American Cancer Society states that some patients will not take their medications as prescribed because of depression or limited emotional support. However, further understanding the literature could motivate them to adhere to a specific regimen and view adherence as a means to well-being and a healthier outcome.

Pharmacy In-Person Consultations

Live patient counseling with pharmacists is the most effective channel for medication adherence. The tenet of “two minutes to trust building” is based on patients having a long-term healthier outcome when they are allowed to speak openly for a minimum of two minutes with free flowing conversation. At the pharmacy, patients discuss sickness more willingly and ask more questions. They are less intimidated by pharmacists than physicians partly because they do not see a huge divide in standing and do not feel a sense of inferiority.

July2016-DiPersioArtwork4A Walgreens study about a cholesterol level lowering regimen showed that patient face-to-face consultations with pharmacists result in the highest medication adherence. At the end of one year, well over 40% of the experimental group reached a target adherence rate of 80% or more, while only a little over 30% of the control group reached the same rate. Pharmacists need to be trained specifically to converse with patients about perception of therapy value, anxiety about side effects, absentmindedness, and the advantage of an established routine for medications. Prior to engaging in an effective consultation, pharmacists should complete a personalized non-adherence risk assessment which includes determining what patients know about their regimen presently, how patients can read labels correctly, their perception of efficacy and safety and the benefits of a demonstration.

In summary, medication adherence was at a standstill – until now. The old adage that talk is cheap certainly does not apply to our forward-looking pharmaceutical industry which recognizes the immense value of communication with adherence. Engaging in a multi-channel communication approach with mobile phone interventions, patient literature and pharmacy in-person consultations increases medication adherence rates, achieves healthier outcomes and lowers healthcare costs overall.



“Improving Prescription Medicine Adherence is Key to Better Health Care.” PhRMA. (2015)

“In-Person Consultation with Pharmacist May Improve Statin Adherence.” MedTera. (2014)

“Medication Adherence Time Tool.” American College of Preventive Medicine. (2016)

Mitchell, A. J. and Selmes, T. “Why Don’t Patients Take Their Medicine? Reasons and Solutions in Psychiatry.” Royal College of Psychiatrists. (2016)

“Patient Education Brochures, Other Approaches May Improve Oral Cancer Drug Adherence.” MedTera. (2014)

July 20, 2016 Kevin Connolly0

Today’s most successful adherence programs focus on the patient, not the product

doctor talking in a callcenterDeveloping successful patient adherence programs is a win on all fronts. Each year, a lack of patient adherence costs the U.S. healthcare system an estimated $290 billion. Indeed, payers benefit in the long run from reduced costs of healthier patients. Yet there are other far-reaching benefits beyond the potential billion-dollar savings. Patients who comply with medication and treatment programs often experience improved health outcomes, and these documented treatment programs can increase the amount of physician drug referrals and repeat prescriptions.

While the traditional approach to patient adherence has been a one-way street — that is, communicating to a patient about what he or she needs to do to stay on a treatment regimen — focusing on a more holistic approach that encourages conversation with the patient can greatly improve the success of your adherence programs.

This approach begins with program design. By ensuring that your program encompasses all facets of a patient’s unique healthcare situation — which includes not only the patient’s health condition and particular medication, but also the patient’s support system or caregivers, socioeconomic status, level of health literacy and other factors — you can set yourself up for success.

Let’s explore the best practices for connecting with patients and the ways you can make your adherence programs both relevant and customizable to the participants’ needs and preferences.

Step 1: Engage with the Patient

It may seem obvious, but it’s often overlooked: Your adherence program can only be as successful as the patients who are enrolled and engaged with it. That means making it easy for patients to learn more about your program and providing multiple access points for patients to register.

This step often begins with a physician. Many patients may not even be aware that these support programs and resources exist for their particular condition or while taking a certain medication. A prescribing physician can be an excellent gateway to acquiring patients for your programs who are interested and engaged from the start. Tap into this resource by reaching out to physicians who prescribe your medication, and share information and materials about the benefits of your program and the complementary support it provides to their patients. This can even prove to be a competitive differentiator. Later, once the program is underway, it’s critical to keep the communication with the physician open and to provide the physician with concise updates on the progress of a patient in a program.

By knowing your audience and recognizing the levels of engagement, you can recommend and deliver a multifaceted program that reaches the patient (as well as his or her caregiver, when necessary) and the physician.

Focusing on engagement from the start reminds us how the best adherence programs are patient-centered, not exclusively product-focused. In the next steps, we’ll explore the ways participants can help drive the conversation, and not be solely a listener, in these programs.

Step 2: Make Your Program Relevant

First things first: ditch the script. Whenever possible, your adherence program should feature applicable content delivered by flexible guides. Allowing your agents to use their own words within the guidelines of approved messaging is much more well-received by a patient than a script read word-for-word on a call.

Furthermore, have you considered the critical role your agents play in making your programs relevant? Your agents are more than message-deliverers; they are supporters, educators, and advocates, and they provide resources that are useful and helpful to each patient’s full scope of care. Consider the ways you can best match your agents with the content they deliver — for example, is healthcare background necessary? If so, would a certain healthcare specialty or other experience (such as social work or psychology) be most beneficial? Once you’ve found the appropriate match, allowing your patients and agents to develop one-to-one coaching relationships throughout the course of your program can pay dividends in improving patient satisfaction and compliance with the program.

Consider this example of a cancer adherence or support program. The nature of this type of program lends itself to having a qualified agent who is intimately familiar with the complexities of cancer care, such as an oncology nurse. While sharing the expected side effects of the treatment itself is important, it is crucial for the nurse to also become a complete resource to the patient — creating opportunities for two-way conversation in order to help the patient overcome their health challenges. That might mean answering questions or providing resources about how to cope with side effects (and directing back to the physician where appropriate), providing nutrition and stress management tips, or even assisting with the coordination of transportation or questions regarding insurance coverage.

Without a doubt, one of the key values of adherence programs that emphasize engagement is that the content itself is relatable and considers health literacy. Engagement-focused, patient-centered programs convey content in easily understandable, conversational terms; they stay fresh over the course of a program; and they empower patients to be involved in their care.

Step 3: Customize Your Program

Personalizing your adherence program can go a long way in achieving better outcomes. The program’s communications — or more specifically, the conversations that take place — should be customized to enhance engagement, increase the program’s success rates, and ultimately, improve the patient’s health.

Early on in your program, conversations with the patient can uncover personal barriers to adherence — physical, emotional, practical, or otherwise. These barriers can range from undesirable side effects (“This drug makes me feel nauseous”) to indifference (“It doesn’t matter if I really take this drug”) to cost (“I can’t afford to take this drug”). A personal relationship with the patient can allow an agent to pick up on those cues in conversation, so that these barriers can be addressed throughout the full course of the program.

Because patient side effects and adverse events can vary throughout a treatment regimen, it’s crucial for the agent to have that personal relationship with the patient so they can guide them through the treatment protocol, while also listening carefully to report key data that offers valuable insights to improve the patient’s health and, in the long run, potentially even improve the drug itself.

Once you have designed and implemented an adherence program that is engaging, relevant, and customizable to the patient, be sure to measure your program data to evaluate its success versus the developed outcomes criteria. Work with your client to understand the measures of success in their eyes. The data collected in your program can yield valuable insights to help you enhance your programs in the future.

July 8, 2016 Bob Ehrlich1

I could not leave last week’s column on media inspired patient fear without another example. The excellent New York Times reporter Gina Kolata did a story on patients resisting drug treatment for osteoporosis out of side effect fears. The story in the June 1 New York Times said millions of people were forgoing osteoporosis drugs out of fear from exceedingly rare side effects.

Ms. Kolata highlights the problems doctors are having convincing patients who need drugs to start therapy. Use of these drugs has gone down by 50%. The incidence of broken thighbone side effects is 10-40 patients for every 100,000 and one in 100,000 for broken jawbones. This means millions of sufferers of osteoporosis are needlessly suffering fractures because they fear side effects.

Bob Ehrlich
“FDA needs …much better guidance on quantifying risk.”
-Bob Ehrlich

Who is to blame? The media reports are partially to blame because they do not give the minuscule odds of a side effect compared to the effects of non-treatment. Lawyers are to blame fishing for patients who take these drugs and claim side effects. How many commercials do we see from lawyers listing a litany of drugs that may have caused side effects?

The FDA is to blame for requiring these extremely rare side effects be part of the ads. While every patient should know the risks, saying fatality in an ad without context is a disservice to patients. What we need is a reporting of the odds of a serious side effect, not vague terms like rare. Consumers will overstate the odds if they hear the word death in an ad. I doubt too many consumers would avoid a drug with a one in a 100,000 incidence. To consumers, words like rare could mean 1/100 not 1/100,000.

FDA needs to have a much better guidance on quantifying risk. Serious risks require clear quantitative odds of occurrence. Patients deserve it. The media should also be held to a high standard when doing their sensationalist stories on drug risk. As this article reports, scared patients make irrational risk/benefit decisions.

July 1, 2016 Bob Ehrlich0

The media seems to look for stories that show how dangerous prescription drugs can be. They routinely exploit consumer fears by over hyping a bad side effect or a death from a drug. “Deadly drug in your medicine cabinet” seems to be a popular story that is used as a teaser to get viewer attention and boost ratings.

The media seems to disregard the potential harm these stories do to patients who are taking these drugs and stop therapy after seeing the hyped risk story. Then there are those who will be scared to start taking them who would benefit. There was a very good story on Vox on an estimate of British consumers who stopped taking Lipitor. The London School of Hygiene studied the effect of negative media reporting on the use of Lipitor. They estimated 200,000 patients stopped taking the drug and estimated 2000 might suffer heart related events because of it.

Bob Ehrlich
“Fear gets viewers and ratings.”
-Bob Ehrlich

The popular media outlets have enormous power and influence. The news media can create  overhyped fear. Take the Ebola virus coverage which caused enormous concern over visitors from stricken countries. The media can serve a very useful role in public health but generally errs on the side of hyping fear. Fear gets viewers and ratings.

What I would love to see is fair reporting in the appropriate context. Zika may be a big problem but the overwhelming number of pregnant moms will not contract it. Fear changes behavior and can lead to unintended negative health consequences. Look at the anti vaccine movement led by many non-scientists. They have managed to use their anecdotal stories to convince parents to eschew vaccines and cause outbreaks of measles and whooping cough. The media has given these anti-vaccine proponents coverage who have no scientific evidence to prove their claims.

Drug companies are particular targets of negative coverage. The media seems to be very willing to savage a drug when a death is attributed to one. In the guise of exposing their supposed urgent news, they are in fact scaring people off life saving therapy. They force physicians to field calls from anxious patients asking to be taken off the drug mentioned. Sometimes the media may be right in exposing a bad drug but it happens rarely. Most of the time they over hype the negative leading to bad decisions by patients.

Drug companies sometimes are forced to withdraw a good drug because the negative press makes selling it difficult. Lawyers jump on the media coverage with their DTC ads asking patients to call to see if they can sue. Physicians get scared away from prescribing a media criticized drug. The FDA gets pressured to pull the drug or add severe warnings. The frenzy deprives patients of a perfectly good alternative.

This Vox story is a good example of what can happen from negative media coverage that  unfortunately is so common.