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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. By 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.

On 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. While 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.

A 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.

SOURCES:

“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)

The irony of the surname of 19th century Scottish author and reformer Samuel Smiles resonates within the pharmaceutical industry in its efforts to bring disease education and prevention to a huge and diverse population. Smiles stated, “Hope is the companion of power, and mother of success, for who so hopes strongly has within him the gift of miracles” – which begets smiles. Pharma has hope for humanity through drug development/dissemination, strategy interventions and funding for both ancient diseases of poverty in developing nations and non-communicable illnesses in developed nations.

Ancient Diseases of Poverty in Developing Nations

Background. Unclean water systems, degenerative housing and unsuitable waste disposal in poverty-stricken developing countries are contributing factors to longstanding tropical diseases. The aim of the World Health Organization (WHO) is to eradicate the following nine tropical diseases within the next four years:  Chagas disease, Dengue, Dracunculiasis (guinea-worm disease), Leprosy, Leishmaniasis, Lymphatic filariasis, Malaria, Onchocerciasis and Schistosomiasis. The great disparity between 90% of diseases being dependent on only 10% of global medical research mandates a call to action to produce better medicines and vaccines. The 90/10 gap is even more disconcerting when considering that over 1 million people succumb to Malaria each year because new drugs to combat the disease lose their effectiveness in a relatively short period of time due to the parasite quickly adapting itself to the newly created drug.

 Strategy interventions. Vaccinations, preventive chemotherapy and concentrated disease management will control and eliminate these targeted diseases. One-time dosages of high quality and safe medications are on tap to be administered as treatment for these nine diseases. On the other hand, single applications are not yet available to handle protozoan and bacterial diseases. Improved case detection and decentralized clinical management are two ways that the WHO intends to prevent mortality for such complex illnesses.

Funding. The Global Alliance for Vaccines and Immunization (GAVI), Medicines for Malaria Venture (MMV), Global Alliance for TB Drug Development (TB Alliance) and Drugs for Neglected Diseases Initiative (DNDi) are only a few of the public-private partnerships (PPIs) formed by governments, health agencies and private industry to overcome tropical diseases. Under the TB Alliance, the Bill and Melinda Gates Foundation and Rockefeller Foundations pledged $40 million to develop new Tuberculosis drugs. The MMV raised $107 million to create anti-malarial drugs while the GAVI raised $2.3 billion to provide access to valuable but insufficiently used vaccines. Along with PPIs, several pharmaceutical companies are donating an unlimited supply of drugs as long as needed to treat tropical diseases. At the same time that GlaxoSmithKline is providing Alberndazole for handling Lymphatifilariasis worldwide, Novartis is contributing an indefinite supply of multidrug therapy blister packs of rifampicin, clofaziminie and dapsone to deal with Leprosy.

Non-communicable Diseases (NCDs) in Developed Nations

Background. Non-communicable diseases (NCDs) are aptly defined as “non-infectious and non-transmissible diseases that may be caused by genetic or behavioral factors and generally have a slow progression and long duration which include cardiovascular diseases, cancer, chronic respiratory ailments and diabetes.” They are impacted by genes, stressful lifestyles in the age of technology and early life environmental factors which are connected to the amount and timing of toxicants and nutrients that infiltrate the placenta. Deaths caused by NCDs are on the rise; mortality is projected to increase by more than half in a little more than a decade.

Strategy interventions. As part of the WHO Global Action Plan, 80% of the basic technologies and high-priority medicines will be made easily available. Lowering deaths from NCDs by 25% by the year 2025 (known as the 25 by 25 goal), lessening current tobacco use by 30% and minimizing the detrimental use of alcohol and lack of physical activity each by 10% are key components of the program. The daunting task of persuading a population to update its life regimen appreciably based on scientific findings may seem unattainable. However, fundamental interventions that are both inexpensive and highly impactful have been identified to assist in the process. Specifically, the WHO initiative addresses a multitude of risk factors that promote healthy living by providing guidance on how to:  1) educate the public on preventing and reducing tobacco use and overconsumption of alcohol; 2) engage in substituting more fruit and vegetables for less fatty foods while reducing amounts of salt; and 3) expand physical activity. Bringing the fight against NCDs and the promotion of healthy living forward at the national level can be brought to fruition if merged into governmental policies that support legislative action.

Funding. Disease prevention and education programs established under the Department of Health and Human Services (HHS) are supported by the formidable endeavors of the National Institutes of Health Research (NIH) and the Center for Disease Control (CDC). For over 20 years, the CDC has provided grants to state and major city health departments to identify risk factors and organize systems to monitor epidemiology and track vaccine-preventable diseases. In 2012, the CDC funded a Field Epidemiology Training Program with over $12 million to prepare trained public health workers to respond to NCDs. In the same year, NIH awarded $14.4 million to scientific institutions for NCD research and surveillance.

In summary, health care in developing nations is designed to treat infectious diseases with ancient diseases of poverty; non-communicable diseases are the priority of developed nations. Pharma is committed to bringing disease education and prevention to both worlds with specific strategies and funding. Its goals are based on the strong desire to reach the masses with pharmaceutical treatments that provide overall wellness and longevity by eradicating ancient tropical diseases and controlling NCDs. The positive attitude of pharma is making a difference in many lives and bringing hope, miracles – and smiles.

References:

“Accelerating Work to Overcome the Global Impact of Neglected Tropical Diseases:  A Roadmap for Implementation.” World Health Organization. (2015)

“Fighting Diseases of Developing Countries.” Parliamentary Office of Science and Technology. (2013)

“Preventing Emerging Infectious Diseases:  A Strategy for the 21^st Century Overview of the Updated CDC Plan.” Center for Disease Control. (2014)

“Primary Prevention:  Avoiding Non-Communicable Diseases by Reducing Early Life Exposure.” National Institute of Environmental Health Sciences. (2015)

“The U.S. Government and Global Non-Communicable Diseases.” The Henry J. Kaiser Family Foundation. (2014)

Social Media, Risk, Cross-Functional and Strategy

Renowned author and literary critic Lawrence Clark Powell said, “Write to be understood, speak to be heard, read to grow.” The idealism inherent in this statement is inspirational for the pharmaceutical industry when overcoming communication challenges. Barriers are eliminated through insightful interpretation of the written word, verbalization of details that ensure full comprehension and total absorption of etched material to expand knowledge base. A smooth and seamless exchange of information results from the creative ways enlisted to handle social media, risk, cross-functional and brand strategy dialogue.

Social Media

In the digital age, it is imperative that pharmaceutical companies have an online discourse with patients to continue moving forward and not fall behind. Facebook is a tremendous opportunity to engage and connect with patients worldwide. The challenge with social media is that the continuous redesign of rules and regulations require strict adherence. Worldwide regulatory bodies, including the World Health Organization and the United National Health Care Organization, mandate the type of drug information companies can disseminate. In the United Kingdom, referring to the name of a prescription drug or an internet address is considered advertising which is prohibited for prescription medications. In the United States, the Food and Drug Administration stipulates that brands must add the associated risk information to their social media campaigns and allow accessibility to effective risk discussions.

Prevailing over this challenge by posting generic – rather than specific – information about drugs creates a community that explores widespread topics and promotes a mission with patients as Facebook “fans.” The potential to advance the corporate image of pharma companies is reinforced when patients read and comment on engaging medical information. Although pharma is not permitted to direct patients about the benefits of medications or which to purchase, they are at liberty to respond in broader terms and promote online drug awareness campaigns. Pharma should delineate the terms of engagement on Facebook pages and state plainly the types of comments that receive a response.

Cross-Functional Communication

In a 2014 study “Pharmaceutical Regulatory Affairs: Arming Regulatory Groups with Voice and Influence to Meet Strategic Challenges,” 48% of drug companies reported a lower level of comprehension with interdisciplinary regulatory requirements. Some internal teams are not aware of the timing of changes in the regulatory environment. These individuals believe that an agency approves a drug merely because it is clinically beneficial but they fail to notice its cost-effectiveness and trial design. Internal groups do not understand fully the impact of regulatory strategy on developing drugs, authorizing medications to be put on the market, and marketing after the approval process has ended.

The remedy is for regulatory affairs to lead discussions with cross-functional teams about processes that provide clarity on current guidelines. Regulators should promote the benefits of guidelines and set forth perspectives and priorities that impact the way prescription medication is developed. Focusing on the rules that increase the chances of medications entering and remaining in the market not only results in improved internal team communications but also stronger relationships with regulatory agencies.

Risk Communication

Communicating risk is a critical component in the reputation of pharma companies. Summary of product characteristics, package inserts, patient information leaflets and cartons are all tools currently regulated based on templates. The call to action arises when the use of templates limits the flexibility of companies to adapt risk messages to certain targets. These templates do not afford companies the opportunity to understand the message perception by different audiences and the fundamental drivers of change in patient and prescriber behavior to increase safety and minimize danger.

The comeback is for pharma companies to assimilate a separate group of communication professionals who focus solely on coordinating conversations aligned with objectives that are accepted by key stakeholders unaffiliated with regulatory agencies. Pharma companies need to emphasize promotional material with supporting factual sources. A team of professionals must determine communication effectiveness, gauge audience reaction and modify the level of risk accordingly. It is essential that trained individuals who know how to manage risk, which may become public later and damage the company reputation, be assigned exclusively to handle the internal dialogue about impactful issues. The relationship between risk communication, perceptions and management is of major concern and it is important that it be addressed.

Drug vs. Brand Strategy

Pharma companies focus their communication efforts on illnesses with the best or “one and only” treatment. In the future, if the severity of diseases diminishes with just one treatment or with only one medicine that is different from others on the market, communication strategies will have less value.  Newly introduced medicines are only unique for a short period of time because constant innovations enable more effective drugs to enter the market. Innovative drugs with reduced prices enter the market and profits decrease.

The technique to settle this is to shift communication strategies from centering on drugs to building brand policies. Connecting brands to concepts makes the pharma industry stronger. Pharma needs to promote what differentiates them from their competitors with a distinguishable brand identity. An umbrella brand protects and empowers medications and also makes it easier to launch drugs that have curative capabilities while a new communication strategy uses brand journalism and consumer engagements to spread the word about the brand. Articulating messages with clarity and being aware of brevity is of utmost consequence. When brand leadership is revealed to the general public, prestige and stature enhance the reputation of the drugs.

In conclusion, communication is a two-way street, but the conveyance does not always occur fluently. Messages from the sender are not necessarily understood in their entirety by the receiver in the intended sense which results in a communication breakdown. Pharma needs to gain the confidence and courage to develop creative solutions that master dialogue challenges with social media, expressing risk, communicating information cross-functionally and brand strategy.

References

“Cross-Functional Communication of Pharmaceutical Regulatory Strategy Boosts Organizational Impact.” Business Wire. (2014)

Cura, M. and Costa, M. “Communication in the Pharmaceutical Industry from Product to Brand.” Developing Ideas. (2015)

Elgie, D. “Pharma Brands on Social Media:  Overcoming the Challenges.” Emoderation. (2015)

O’Riordan, B. “6 Challenges Facing Pharma Communications.” Pharmafile. (2015)

“Risk Communication and the Pharmaceutical Industry.” SpringerLink. (2015)