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The concept of coaching is pervasive in today’s culture with many popular forms: life coach, fitness coach, personal coach, wellness coach, and behavioral coach. Regardless of the topic, coaches help us to take the next step towards achieving our goals. But understanding the purpose behind behavioral coaching is particularly important as we seek to meet patient needs. Behavioral coaching uses evidence-based clinical strategies and interventions to engage patients in behavior change to better self-manage their health[1]. The ultimate goal is to improve health outcomes, lower risk, and decrease costs[2].

Using behavioral science to address adherence barriers is not new to sponsored patient support; in fact, behaviorally based programs have been around for years. However, the application of live, two-way support to identify barriers in real time and deploy specific messaging, resources and coaching support is on the rise.

Digging into behavioral barriers and their importance

Behavioral coaching encourages a two-way, patient-led conversation to uncover barriers to adherence, express empathy, and offer personal support that results in a collaborative action plan to maximize adherence.

Results demonstrate that frequent, personalized interactions with patients create opportunities to reinforce messages about adherence and allow patients to take an active role in managing their own healthcare. By using behavioral-based techniques, pharmacists and trained contact center agents can help deliver impactful conversations with patients.

Increased financial responsibility for rising healthcare and drug costs is a significant issue. However, most non-adherence is not due to drug cost. It is estimated that 69% of the problem is behavioral, such as perceived benefits, poor doctor-patient relationship, medication concerns, or low self-efficacy[3].

Leveraging behavioral coaching techniques

In order to be impactful, therapeutic class insights can be critical to truly understanding patient needs and delivering support that drives improved outcomes. While each patient’s situation may be unique, our experience in behavioral coaching reveals similarities across therapeutic conditions which can be used to infer best practices in addressing patient challenges across brands and patient populations. For example, sensitive conditions (HIV, hepatitis C) have social implications that may require more empathetic messaging than more mainstream chronic conditions (diabetes, hypertension). Patients with a visible dermatological condition (psoriasis, onychomycosis) often face quality of life issues that may require significantly different support.

Helping to overcome these barriers is individualistic in nature, and takes investment, patience, and experience. Behavioral conversations can identify a patient’s position on their treatment paradigm, help them to clearly define their treatment goals, and create a path to reach those goals with dynamic support provided at every step along the journey.

Alignment of goals between the coach and the patient is one of the most important steps in improving outcomes. Patients are more likely to succeed if goals have personal meaning, as opposed to focusing on achieving an external reward or avoiding punishment. A patient’s active engagement is the key to setting goals designed to help them commit to behave consistently and have greater focus on attaining a goal.

Techniques like active listening and reflective response involve patients digging deeper into their personal barriers, which is critical to help set goals, as well as work towards achieving them. Both techniques require focus and effort. It is more than simply listening in order to reply, but listening to understand – not just the words, but the emotion behind the words, that influence the patient[4].

Patient-centered behavioral coaching is designed to help patients determine the way in which THEY believe they need to change their behaviors to achieve their goals. Patients who feel listened to are more comfortable with the care they receive and are more likely to adhere. The way in which the coach responds is equally as important as listening[5]. A good example is smoking cessation. While a smoker knows that smoking is bad, telling the patient to stop rarely, if ever, encourages them to do so and often forces them to defend the very behavior we are attempting to influence. As a result, the patient resists, and presents arguments to counter the proposed change.

How coaching can build an integrated brand experience

Behavioral conversations are designed to “meet the patient where they are,” but this also can refer to the channels through which patients can be coached. The same patients can be touched across multiple channels to enhance the overall patient experience and outcomes. Paramount to building a consistent, impactful support program is to place the patient needs in the center, then build an integrated experience across channels, internal stakeholders, and budgets. Channels where pharma brands may reach patients through coaching include:

1. Phone Coaching: Research shows that phone coaching for people with chronic conditions can improve health behavior, self-efficacy, and health status. Planned phone coaching sessions appear to be most effective for improving self-management skills in people from vulnerable groups. Phone coaching services have the advantage of regular contact – helping people develop their skills over time – and the tailored conversations allow the coach to support the patient’s individual needs[6].

Using dynamic, two-way conversations, coaches can identify adherence barriers and provide targeted messaging to help overcome those barriers, connecting with patients using proven health behavior change tools and techniques. This approach can, with proper consent from the patient, also align personalized messaging with a patient’s co-pay program level data, as an example. Recognizing that adherence barriers change over time, as well as patients’ information and education needs, brands can integrate out-bound support and multi-channel communications to maintain personalized support for patients throughout their treatment journey.

Diabetes Coaching Case Study

Adherence Barriers: The life of a diabetic patient is a juggling act to maintain glycemic control: blood-glucose testing, exercise, and diet. Many Type II diabetics struggle with the condition from the point of diagnosis, and consequently have feelings of failure if they progress to an insulin-dependent state. These issues create multiple challenges to medication adherence, and disease and blood-glucose management. It’s easy for these patients to feel out of control with the regimen complexity and the associated long-term complications. Studies show a significant number of patients don’t take their medications as prescribed, which may reduce effectiveness and lead to additional complications. Increasing adherence in diabetic patients is a tri-pronged approach and an important consideration when supporting the patient.

Program Goal: Improve adherence through providing behavioral coaching individualized to the needs of patients segmented on level of engagement. Results demonstrated that patients who were coached were 25% more adherent to therapy vs. control during a 9 month study. This 25% increase in adherence translated to an increased length of time on therapy of nearly 31 days. The primary conclusion proved coaching increases adherence and is effective across all behavioral segments.

Symphony Health Analytics, 2016

2. Hub Support: Delivering a consistent experience through all patient support programs, from therapy initiation and throughout the patient’s journey, is increasingly important. Many brands have different decision makers leading these initiatives, resulting in a lack of integration between various hub services, patient support programs, and co-pay card vendors. This lack of integration leads to a disjointed patient experience and a missed opportunity to maximize patient impact. Integrating access with adherence is crucial to a patient’s success – and coordinating that support, data integration, and a seamless patient experience, increases patient success.
3. Specialty Pharmacy: With the dosage complexity and costs associated with specialty medications, pharmacies offer varying levels of patient support. When building a comprehensive patient support program, it is critical for brands to understand how the pharmacies’ approach to patient support compliments its distribution model and patient experience goals. For example, Biologics, one of the leading specialty pharmacies in the country, provides patient support through oncology nurses, who are experts in setting appropriate expectations, providing empathy, identifying psychological challenges, and linking the patient to brand approved resources.

The use of behavioral coaching is growing significantly within oncology to support patients moving from an end of life diagnosis to living with a chronic disease. The unique characteristics of oncology patients present complex challenges that impact the best approach to help patients achieve positive outcomes with emerging, specialty pharmacy treatments.

Improving medication adherence

To effectively combat non-adherence, industry must explore patient-centric approaches that increase adherence rates and improve patients’ quality of life. This requires a shift from short-term initiatives to longer-term strategies, recognizing that behavior change takes time.

Behavioral coaching conversations that leverage powerful tools, such as active listening, open ended questions, and reflective response have consistently increased adherence. These conversations allow patients to dig deeper into their own personal barriers, to help coaches and clinicians set appropriate product expectations, leverage available resources, and develop a plan of action to prevent non-adherence. Ultimately, the strategic balance between patients’ needs and brand goals results in a scalable adherence solution that builds patient engagement, giving brands the ability to optimize patient spend and identify communication strategies most likely to meet the needs of targeted patients.

References

[1] Huffman M., Miller C. (2015). Evidence-based health coaching for healthcare providers (3rd ed.). Winchester, TN: Miller & Huffman Outcome Architects, LLC. Google Scholar

[2] Judith H. Hibbard and Jessica Greene What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs Health Affairs 32, no.2 (2013):207-214 doi: 10.1377/ hlthaff.2012.1061

[3] http://lab.express-scripts.com/lab/insights/adherence/a-new-perspective-onnonadherence; http://healthitanalytics.com/news/69-of-medication-non-adherencedue-to-poor-patient-behaviors

[4] http://www.guilford.com/books/Motivational-Interviewing-in-Health-Care/RollnickMiller-Butler/9781593856120/reviews

[5] http://www.guilford.com/books/Motivational-Interviewing-in-Health-Care/RollnickMiller-Butler/9781593856120/reviews

[6] (Aust Health Rev. 2013 Jun;37(3):381-8).

Nurses today are in an optimal position to help pharmaceutical companies. According to the American Nurses Association, nursing professionals have high levels of trust in terms of consumer perception for the past 15 years, and nursing reliability and expertise is recognized within the healthcare profession.

Yet the critical functions of nurses within the pharmaceutical industry can be easily overlooked in comparison to traditional clinical positions. That’s despite the fact that nurses play vital roles in communicating information both to and from the patient in pharmaceutical settings.

For example, a nurse health coach delivers key information and support to the patient during medication adherence and patient engagement programs. Likewise, nurses on pharmacovigilance (PV) teams process information from the patient, applying their analytical skills and clinical knowledge to improve the safety profile of a drug or device.

Both the patient engagement and PV nursing roles necessitate empowerment and smart decision-making. Research demonstrates that empowered nurses empower patients, resulting in improved outcomes. Nurses within the PV sector need to be empowered to make the best decisions given the information at hand.

Bringing their best work

On a typical day, a nurse on a PV team may receive and review safety information from a variety consumer and healthcare professional sources. Using clinical and analytical expertise, the PV nurse summarizes the information and submits safety data for pharma representatives’ assessment against the safety profile of their drug or device. PV nurses are also a resource for investigative sites with respect to reporting safety information that protects consumers. Soliciting and processing follow-up information is a key responsibility of PV nurses to ensure that pharma companies, regulatory authorities, healthcare professionals, and patients have complete information regarding the safety of consumer drugs and devices.

At every step of the way, PV nurses should be empowered to do their best work. This starts with their clinical expertise. I encourage the nurses on my team to build upon their clinical experience to better understand disease processes or conditions beyond what is apparent at the “surface level.” As part of that process to dig deeper, nurses need to understand the gray areas and be prepared to navigate murky waters. That involves knowing what is important to extract from the data they receive and applying the right analytical skills, in addition to using their clinical background knowledge.

What’s the benefit?

While in a conventional sense PV nurses may not be considered for their significant role in disease education and awareness, they certainly serve a crucial role as protectors of the consumer. Their work affects research processes and outcomes that will influence disease or condition management in the years to come. The work done and the information processed by the PV nurse have the power to improve drugs and devices, change clinical practice, and improve patient safety outcomes.

In the end, nurses within every role — whether pharma or clinical, health coaching or PV — play a vital role in our healthcare system. Pharmaceutical companies should leverage the vast experience and knowledge nurses can bring to the table. Empowered nurses are powerful agents of change that have positive effects on the pharmaceutical and healthcare industries, and within society at large.

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In light of the upcoming Men’s Health Month in June, I thought it relevant to talk about one of the biggest challenges pharma marketers have come to PatientPoint for help with: how to engage men and get them talking about their health. While George Clooney has always been my ideal target, for pharma brands, the challenge is getting their message to men at the most impactful moments when they are willing and ready to act. Those moments are rare.

According to a recent survey, in the last year,¹

• Almost one-fourth of all men had not seen a doctor
• 1 in 3 men had no regular doctor
• More than half had not gone in for a routine checkup

Further, nearly seven out of 10 men with advanced prostate cancer ignore their symptoms.² These statistics are not just shocking, but concerning. That’s why we fully support movements like Men’s Health Month and organizations like the Movember Foundation that speak to men in a way that gets their attention and encourages them to take better control of their health.

These initiatives represent a huge opportunity for pharma brands to be involved in the conversations happening outside of the doctor’s office. But I want to focus on what, I believe (and is in my sweet spot), is an even greater opportunity—inside the doctor’s exam room. It’s here where men’s attention and willingness to engage has peaked; they are in a private space and can be vulnerable about even the most sensitive conditions. They’re attuned to their health, and they’re ready for the right information from their physician and you.

Our presence in the exam room with the PatientPoint urology educational program has shown us the exact type of messaging that resonates with a male audience to get them to speak up. My recommendations:

1. Spark a conversation

While many initiatives are catchy and get men to think about their health, the most important conversation happens inside the physician’s exam room between the man and his doctor. That’s the conversation that leads to action—and prescriptions. Being present in exam room educational materials that men can peruse while waiting for the doctor to enter primes the conversation about to happen. Topics like erectile dysfunction or prostate problems aren’t easy to bring up. Our brochures offer men starter questions and discussion prompts to get the conversations going.

2. Catch his attention

A brand in a plethora of many isn’t going to catch anyone’s eye. Category exclusivity should be a crucial component of your marketing strategy in the exam room to ensure your brand is the only brand the man sees.

3. Tell him what to do

More than half of men say they find great value in information available when deciding what drug to take—so tell him! Offer a discussion guide that men can use to start talking with their doctor, provide calls to action that prompt men to ask the doctor about a specific topic or bring attention to symptoms that may lead to a better, more productive discussion with the doctor, and better health outcomes overall.

Helping enrich that discussion keeps you top of mind at the moment of script and reinforces your brand when men are at home or with their partner reviewing the brochure they took from the exam room: 68% of men strongly agree it’s their responsibility to inform themselves about the medicine their doctor recommends.³

There’s no greater opportunity for pharma brands to make an impact on men and drive greater effectiveness than in the exam room. Make sure your brand is the only solution top of mind when men are actually ready to take action about their health and talk to their doctor.

References

1. Commonwealth Fund survey
2. The International Prostate Cancer Coalition, Bayer HealthCare, Harris Poll—Prostate Cancer Symptoms Survey
3. ID Media, New Realities study