The word is out. Suppliers to large pharmaceutical companies seem to have gotten the message that patient compliance is a huge problem — and a tremendous missed revenue opportunity for their Pharma clients.

The supplier response has been predictable, substantial… at times comical. One by one, the suppliers have come out with bold statements and aggressive advertising, explaining how they're in the process of committing massive resources and attention to the patient compliance problem. Huge proposals… impressive flowcharts… integrated solutions (that don't really exist)… and monumental price tags (that do).

But buyer beware. There's a herd mentality, and as a pharmaceutical executive, you'll want to take a breath and be leery of the stampede of companies now trying to cobble together disparate people, functions, information and technology — complicated moving parts, most of which have never before even spoken to each other.

And here's the rub: Even if it were easy to piece it all together, the approach — which takes the doctor out of the mix and attempts to connect a third party directly to the patient — is doomed from the start.

	The solutions are misdirected at the peripheral issues associated with the compliance problem.

In a nutshell:

1. It all starts with the doctor. The physician who makes the diagnosis and prescribes the medication has the most influence over whether or not a patient will remain compliant. Reminding a patient to take his medicine via a third party might help temporarily, but it's an after-the-fact band-aid; it doesn't address (in any way) the "why's" of that particular individual's noncompliance.

   In the long run, it's the why's that make the difference. You'll only uncover those if the doctor is in the loop from the start (see previous FUSE article, "Patient Compliance: A Case Study in Success," for more on this).

2. Patients are motivated by better communication with their doctor. Our direct experience with over 250,000 physicians over the past decade suggests that the single biggest motivation for people participating in our programs is the hope that their involvement will result in better communication with their doctor. Patients want to know that their doctor is in the loop — their loop — and value an approach which provides upstream information back to the treating physician.

   An anonymous third party check-in that drops in out of the sky will do little to move the compliance needle. At worst, it will disturb the doctor-patient relationship, adding confusion and even mistrust to the mix.

3. Doctors don't want to abdicate responsibility. No good doctor wants to be taken out of the treatment conversation with his patients, particularly if it means handing over the communication role to an intrusive and ineffective third party. Most, however, do want help and support in managing compliance issues.

   Consider this (using NCPIE Coalition data)…

   In an average primary care practice of 2,000 patients, 60% (1,200) are "on medication." In practice, however, nearly one third neglect to fill the prescription (400). Even among those who do, over one quarter (200) will stop using the medication before the treatment regimen has concluded. Taken together, this means that at any given time, the average primary care doctor has 30% of his patients (400+200) out of compliance.

   Unfortunately, given the workload, doctors simply cannot stay on top of this communication problem — and it is a communication problem — on their own.

   The compliance solution, therefore, will be found in:

   1. the design of simple content that provides both parties with essential information, and
   2. the facilitation of patient-physician dialogue outside of the doctor's office visit.

Doctor end-arounds don't work

Direct to Patient schemes have been around for a long time and fundamentally have not worked, principally because the physician has been left out of the equation. In the end, doctors are and always will be our best ally in resolving the patient compliance issue.

The solutions which empower the physician to better manage and relate to his or her own customers will carry the day. Absent that, it's all just a lot of smoke and mirrors.

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Tapping into the Physician's Aura

Adherence for the patient is an uphill struggle. Human nature is such that forgetting, or not wanting, or not bothering to take prescribed medication (particularly with asymptomatic conditions such as hypertension) is something most patients struggle with day-to-day.

To counter this natural tendency among patients, we must tap into the "physician's aura."

We know from experience with our programs that a desire to act on the treatment recommendations of one's doctor has tremendous influence over behavior… provided the patient knows that those actions are communicated back to the doctor.

Why? Because for most people, the doctor/patient relationship is like that of teacher and pupil. The doctor has an aura of benign, all-knowing expert, and our experience has demonstrated time and again that a direct request by a doctor is stronger than that of parent, spouse, child or close friend — the patient wants to do something to please him.

But the aura dissipates quickly. Office visits are few and far between, and the key, therefore, is to give the patient the feeling that his doctor is always involved. In our surveys we specifically and deliberately say, "Your doctor will be expecting your results." That statement, more than anything else we can say or do, has proven to have the most influence over patient behavior.

When we "extend the aura" of the physician — through programs which enhance doctor-patient communication and solidify the feedback loop — we help patients be more compliant.

Download (at no charge) a PharmaVoice podcast featuring our own Michael Ball (VP of Marketing) and Paul LeVine (VP of Analytics): "Own It: Transforming Public Perception of Pharma through Better Sales & Marketing Practices."

In this 13-minute episode, Mike and Paul talk about three key areas of brand management: public perception, principal stakeholders, and technology in sales and marketing practices.

Click here to listen to a soundbite.

Click here to download the entire 13-minute episode.

"Many physicians believe that a better educated patient (in terms of their disease) will lead to less questions for the practice and less phone calls to the office."

— InfoMedics Research, Fall 2006

InfoMedics creates an interactive, real-time means for helping patients and physicians better communicate about a diagnosed condition or prescribed treatment.

This results in improved health outcomes and consistent increases in prescribing levels for new prescriptions and refills.

October 2007

September 2007

July 2007