Words by Kirstie Turner
Low medication adherence brings with it a complex array of challenges for the pharmaceutical industry. Several companies are developing digital solutions to face the adherence crisis head on.
In the pharmaceutical industry’s quest to provide drugs to treat, prevent, and cure all conditions, medication adherence is proving to be their Achilles heel. Poor adherence poses a myriad of challenges: it stops patients from getting better, costs healthcare systems vast amounts of money, and contributes to antimicrobial resistance, one of the greatest health threats of the modern age. There is a labyrinth of reasons behind low adherence that must be navigated. Can innovative, digital solutions stop adherence from becoming the chink in pharma’s armour?
There were a record 59 drugs approved by the FDA last year, but new medications are only going to be successful if patients adhere to their treatment. It is critical to understand the wealth of possible reasons for poor adherence, such as the side effects of a treatment, as these will act as the catalyst for solutions. Completing antibiotic courses has long been a challenge because patients often stop taking antibiotics as soon as they feel better, instead of completing the course and ensuring eradication of the bacteria. In the USA, companies must disclose any risks when advertising drugs; this often-extensive list of side-effects can be off-putting for patients. The reason for some people may even be as simple as forgetting to take their medication.
Many of those working within the realm of healthcare are unaware of the presence of, and reasons for, poor drug adherence, as David Chandler, Lay Member, NICE, explains: “People with terminal cancer were stopping taking their medication during the course of the treatment. I was completely flabbergasted by that.” He investigated further to find out why: “The treatment caused them severe side effects.”
Pharma must work with healthcare professionals to outline to patients that, while side effects may be severe, the benefits will outweigh this, as well as educating them on the risks of not sticking to their treatment plan. The method in which this is done is key, as Chandler describes: “Be considerate around explaining the negatives … [explain that] there is a negative, but the benefit is so much greater: weighing that risk and benefit is really important.”
Vaccines are a prime area for focussing on improved medication adherence. At the eyeforpharma Patient Summit Europe, Philibert Goulet, Head of Patient Office, GSK Vaccines, outlines the drivers of hesitancy: “Confidence is the mistrust in the safety and efficacy of vaccines, and more broadly the mistrust of the health system generally… complacency is the underestimation of the impact of infectious diseases – it is quite frequent… and convenience is the fear of needles on one side and the effort of creating an appointment, when you aren’t sick.”
Once they had identified the reasons behind the poor adherence, GSK developed a solution: they created an online, double-blind community called HealthMakers, which enabled them to hear consumers’ views and concerns surrounding vaccines. When educating patients on vaccine uptake, “it is important to provide the results of the science in a language that everyone can understand and not feel excluded”, explains Goulet.
Pharma often have the issue of mistrust to contend with, or feelings that they are biased with their information on the success of vaccines. Goulet recognises that they may not be best placed to improve adherence, but could utilise their connection with HCPs: “We should increase our efforts collectively to provide HCPs with relevant and appropriate content for them and their patients.”
Another approach to improving medication adherence comes from the innovative app Drug Stars. Users are rewarded for sticking to their medication plans: stars are earnt which can be used to donate money to one of their partner charities. A recent study of the app on a cohort of Danish patients with epilepsy showed that 33% of participants improved their ability to remember to take their medication and 28% were more motivated to do so.
At the eyeforpharma Patient Summit Europe, Claus Møldrup, CEO and Founder, Drug Stars, explains the reach of the app: “Any patient in the world can participate in our programme: it’s completely free. Any patient charity can be a partner with us: it’s also completely free for them.” The more charities they collaborate with, the more direct lines of communications are opened with patients, as Møldrup continues: “Patient charities are giving us access to the patients who are then downloading the app.”
They have coined the term ‘Giving by Taking’, which gives patients a stronger incentive by framing a consequence of adherence: by sticking to their treatment plan, they are helping other people living with the condition. And it seems to be working, as user numbers rise: “In the UK we have 37,000 users who are recording medications and they have done >60,000 reviews”, says Møldrup.
With an onslaught of exciting developments across a range of therapy areas, it is critical that this progress is not hindered by the challenge of adherence. An open conversation with patients is sorely needed, along with the creation of innovative methods, such as Drug Stars and HealthMakers, to address the causes. Investing time and money into this realm will help to ensure that pharma do not become ensnared in the trap of low adherence on their mission to help patients.