AMCP: Improving Adherence Means More Than Just Information

The effects of treatment nonadherence are serious and include poor or less than optimal clinical outcomes, higher mortality, lower quality of life, reduced productivity, and increased costs and stress on the health care system, Laura J. Moore, EdD, CHES, CCLS, lead health psychology specialist, Atlantis Healthcare, told attendees at AMCP Nexus.

The biggest predictors of medication nonadherence among patients, according to a survey of nearly 20,000, are a lack of perceived necessity for the treatment, concerns about side effects, concerns over taking medications, and their costs [McHorney CA, Spain CV. Health Expect. 2011;14(3):307-320].

“People need to understand what is motivating them and what things are holding them back. This will be different from person to person and from situ­ation to situation,” said Dr Moore. “People need to be reached where they are and given opportunities through different channels to explore the beliefs, perceptions, and other factors that are holding them back.”

Effective patient support programs motivate and facilitate positive behaviors for adherence, Dr Moore explained. They also educate patients about their condition and treatment, address any comorbidity and polypharmacy issues patients may have, and help them to develop the range of skills necessary to self-manage better.

Importantly, the channels for patient support do not all look the same or reach every patient in the same way. As Dr Moore pointed out, one size does not fit every patient.

EXAMPLES OF ADHERENCE SUPPORT

A low-cost, effective intervention Atlantis Healthcare used to improve use of preventer medication among patients with asthma was text messages. Patients received messages that promoted illness perceptions and medication beliefs associated with adherent behavior. Over time, adherence grew 38% and the number of patients using greater than 80% of their asthma preventer medication more than doubled.

Creating a quarterly magazine geared to women with breast cancer was another adherence initiative Dr Moore discussed. The magazine educated women on what to expect with treatment side effects and used storytelling to address their concerns. That patient support intervention cut the rate of treatment discontinuation at 6 months from 27% to just 4%, the presenter reported.

 “Adherence is really everyone’s responsibility,” Dr Moore said. “Individuals, health care providers, payers, and pharmas all play a role in managing adherence.”—Jolynn Tumolo