Words by Kirstie Turner
When considering the vast challenge of medication adherence, the proverb ‘you can lead a horse to water, but you can’t make it drink’ springs to mind. Pharmaceutical R&D spending is predicted to hit $181 billion per annum by 2022, as the industry strives to continually improve outcomes for patients, but without improved adherence, new treatments will not reach their full potential. Medical affairs have the skillset to be the leader in the adherence challenge – guiding patients through the treatment journey and offering education, motivation, and support to reach the final destination: improved quality of life.
Adherence is a complex issue that occurs for a multitude of reasons across the patient journey, from avoiding side effects and lack of understanding, to lack of funds or accessibility to collect prescriptions. It is not just relevant for medication, but also for lifestyle choices, which can significantly impact treatments. Michal Konštacký, Global Medical Affairs Director, Takeda, explains: “Medications which don’t immediately affect somatic symptoms typically have poor adherence. Patients with chronic diseases like asthma, COPD, lipid disorders, and diabetes not only have suboptimal adherence to medication, but also to other recommendations such as suggested diet or regimes (e.g., smoking cessation) which might be crucial to long-term treatment outcome.”
To address the complexities of medication and lifestyle adherence, better education is critical. As the communicators of scientific knowledge, MA are in a unique and suitable position to carry out this task. Eric Bouilloux, Associate Vice President, Scientific Affairs, Accord Healthcare, discusses: “MA have a critical role to play as suppliers of key medical education to the HCP and, where appropriate, to patient association groups. MA need to fully fulfil that role of data dissemination in the ever-evolving disease knowledge state and provide all the information and tools enabling efficient and the most convenient use of products available to the patient across the spectrum of options.” It is not simply about telling patients why they should take their medication – but providing support for the challenges that lead to poor adherence.
Technology is being utilised to identify poor adherence and spark conversations around the issues that lead up to this. Konštacký explores: “There are gadgets which help you to see, for instance, where patients are using their long-term asthma medication, like inhaled corticosteroids, and you can learn that they have been spraying their inhaler 20 times, moments before entering the doctor’s office, so they can pretend to comply. It is important to explain to the patient that they are not cheating their doctor, but themselves.” Often, patients are giving up on medication or lifestyle changes before the impact is visible, so they aren’t aware of the benefits they could be missing out on.
MA need to fully fulfil that role of data dissemination in the ever-evolving disease knowledge state
For many patients however, education is not enough. They may be well aware of the ramifications of not adhering to their treatment plan, but still choose not to. The negative impact or challenges may outweigh the benefits. In these cases, MA may have to look not just at education, but at motivation. Konštacký says: “The role of medical affairs is not to scare patients, but to create motivational tools. Motivating patients will be an even more prominent task in upcoming years.”
“Some companies use gamification. In diabetes for instance, patients can collect points for insulin treatment adherence, and the pharma company, based on the level of adherence, donates insulin to developing countries on your behalf,” continues Konštacký. Tools such as this can encourage better adherence in patients motivated by doing something positive for those less fortunate, rather than being guided by education on how this insulin will impact their own lives.
Konštacký shares another approach: “You have some gamification that plays on the community element, where patients can compete with other diabetics to improve adherence.” Again, this captures a different segment of patients, who may be driven by the feeling of community, or by a competitive spirit. For Konštacký, elements such as these “tick all the boxes for an impactful MA tool.” The adherence challenge is vast – and tools such as these can help MA along the way.
By developing a strategy that begins with an investigation into the reason for poor adherence, followed by an approach towards addressing these challenges, MA can use their unique standpoint to educate and motivate a new wave of adherence for patients, ultimately serving their long-term quality of life. We must work to show patients that there is a light at the end of the treatment tunnel, offering support and knowledge in swathes along the way.