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Driving Patient Compliance

By Pietro Bonacossa Posted on: 03 Feb 03


Non-compliance is the failure of patients to take medicines in their prescribed manner. Patient non-compliance is a serious healthcare issue, with studies showing that it can range from 20% to 80% dep
The Scope of the Problem Non-compliance is the failure of patients to take medicines in their prescribed manner. Patient non-compliance is a serious healthcare issue, with studies showing that it can range from 20% to 80% depending on the type of treatment (1). The problem of non-compliance is not a new one and has been investigated for several decades worldwide. The Consequences Patient non-compliance lessens the quality of healthcare and can lead to dangerous consequences for patients. In the USA, it has been estimated that non-compliance causes 340 deaths per day and that is responsible for 10% to 25% of hospital and nursing home admissions. Patient non-compliance is taken so seriously in the USA that the New York Times dubbed it the nation's "other drug problem" (2). For example, a recent study conducted by Dendrite's Analytika Division and based on an analysis of data from nearly half of the US retail chain and independent companies discovered that "fewer than one in four patients on a cholesterol-lowering therapy completes a full year of treatment" (9). For pharma, this gap between compliance and persistence translates into vast amounts of lost revenue. The importance of patient compliance is well known in the treatment of HIV infection with antiretroviral drugs (3-5). The antiretroviral therapies that are now available have the potential to achieve and sustain suppression of viral replication in many individuals, thereby transforming the outlook for patients (6). A number of studies carried out have shown that the rate of compliance to antiretroviral therapy correlates highly with clinical success (3-5). However, these studies have also concluded that almost perfect compliance is necessary. Patient compliance of 80% to therapy resulted in viral suppression of less than 50%, and even between 95% and 100% compliance viral suppression was only 81% (6). Furthermore, if compliance is sub-optimal it may promote the development of viral resistance. This would limit the treatment options for such patients in the future. The economic angle Patient non-compliance also has an important economic impact on healthcare. Patient non-compliance costs the US economy around US$100 billion per year and of this total, lost pharmacy revenues account for US$8 billion (7). With the allocation of healthcare resources becoming such an important issue for governments, healthcare providers are keen to tackle the problem of non-compliance. There are significant financial implications for the pharmaceutical industry when patients do not adhere to their prescriptions, as recommended by their doctor. Non-compliance costs the pharmaceutical industry up to US$70 billion each year (7). Companies have started to implement compliance programmes for patients and have also invested in developing appropriate formulations of drugs that might encourage better patient compliance. With a better understanding of prescriber behaviour and patient responsiveness, companies can achieve higher returns by eliminating costly, ineffective outreach efforts. A good example of the way the pharmaceutical industry has attacked the problem of non-compliance is illustrated by the antiretroviral treatment of HIV infection (6). Clinical data suggests that near-perfect adherence to therapy is required for a maximal response to HIV therapy, but compliance rates in studies have been shown to vary between 33% to 100% and often decreasing over time (4). Studies have also shown that whereas once-daily and twice-daily treatments were associated with good compliance, this was not the case for treatments that had to be taken three-times a day (6). It was concluded that once- or twice-daily treatments were more successful as they fitted in better with the lifestyle of patients. Similarly, the use of fixed-dose combination antiretrovirals, which contain 2 or 3 antiretroviral drugs in a single formulation can improve compliance (6). The use of these combination antiretrovirals also helps in preventing sub-optimal therapy that can lead to viral resistance (6). The problem lies in the fact that while traditional prescription-based data provides information about products' market share and volume, it does not show information about therapy length or a detailed view of recent changes in physician prescribing behaviour - data that pharma could use to launch sales and marketing activities. New technology has revolutionized the way anonymous prescription data is analysed. Instead of prescription-based studies, companies are adopting prescriber-linked, patient-measure analyses that include information about "how many new patients try a brand because of a new prescription start or therapy change" (9). This type of "longitudinal" data - known as LRx data analysis - helps pharmaceutical companies better tailor costly interventions and reduce delays in clinical trial recruitment, by finding suitable prescribers as potential investigators and patients as participants. In addition, this information gives pharma manufacturers more insight into doctors' dispensing patterns and patients' behaviour. Compliance as an issue in clinical trials The importance of patient compliance is also well recognised by those running clinical trials, as it has an important bearing on the evaluation of new drugs. Even though compliance in trials is often better than that seen in general clinical practice for many conditions, patient compliance is an important issue that must not be overlooked. For example, a Canadian study focusing on migraine concluded that a better adherence to treatment could improve health outcomes, but that the compliance strategies available were mostly ineffective and were not well assessed (8). The therapeutic gain in many studies was, at best, in the order of 30% to 40%, but through effective compliance strategies the author suggested that the frequency of migraine attacks could be reduced by 50% (8). Paying attention to compliance issues is therefore essential to ensuring that the data collected during trials is as accurate as possible. When planning trials, clinical teams aim to ensure maximum patient compliance. Compliance will be affected by factors such as the duration of the treatment, the number of times a drug has to be taken per day and potential side effects. What can healthcare providers do to ensure patient compliance with pharma treatment? Although pharmacists, nutritionists, nurses and physical therapists may not write prescriptions, they can reinforce doctors' recommendations and help redirect consumers' preconceptions, reinforce compliant behaviour and relate to patients on a personal level. "They're the ones patients talk to about their medications and how they feel about their treatments", says Joan Sinopoli, president of the market research company Consumer Health Sciences. (10) Conclusion Regardless of the science and medical technology behind a particular drug, it will only be therapeutically effective if a patient takes it according to their doctors' recommendations. Today, patient compliance and persistence enhancement programs are often missing from pharma's marketing mix. However, such programs not only improve patient outcomes, they also boost pharma companies' revenues. Companies should use patient-centric longitudinal data management and analysis to more precisely target consumers that doctors have already qualified as treatment candidates. Simplifying dosing regimes, reducing the number of pills to be taken daily and developing formulations tailored to a patient's lifestyle can all help in this regard. More efforts also need to be made by healthcare providers to understand why patients do not fully comply with their treatments and how this problem can be addressed. References 1. Jaret P (2001). 10 Ways to Improve Patient Compliance. Hippocrates: Practical Advances in Primary Care. 2. The New York Times June 2, 1998. 3. Paterson D. et al. (1999). How Much Adherence is Enough? A Perspective Study of Adherence to Protease Inhibitor Therapy Using MEMSCaps. 6th Conference on Retroviruses and Opportunistic Infections (CROI). 4. Miller L et al. (1999). Providers Estimates of Adherence Overestimate Reports From Medication as Monitoring Systems (MEMS) for Patients on Protease Inhibitors (PIs) 5. Elion R (2002). Update on Adherence: Interventions and Outcomes. 9th Conference on Retroviruses and Opportunistic Infections (CROI). 6. The Importance of Adherence in Antiretroviral Therapy. 7. Forum on Patient Compliance 2002. Center for Business Intelligence. 8. Aubé M.(2002). Improving Patient Compliance to Prophylactic Migraine Therapy. Can. J. Neurol. Sci. 29: Suppl. 2 - S40-S43 9. Newsom J. (2002). Power Profits Through Data. Pharmaceutical Executive, August 1, 2002. 10. Shalo, S. (2002). Industry Insider: Cast a Wide Net. Pharmaceutical Executive, July 1, 2002.

Pietro Bonacossa

Last updated on: 27/08/2010 11:40:18

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