Adherence Begins Before Treatment: EXL Adherence Summit Presentation


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HealthEd presentation "Adherence Begins Before Treatment: 5 Strategies You Must Consider To Drive Effective Patient Interactions" at the 2nd annual ExL Pharma Patient Adherence Summit in Philadelphia.

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  • Instead we suggest a different approach- by placing the patient as the center of the marketing focus and acknowledging and messaging to their values…. (barriers and motivators to behavior), Knowledge (about disease, and rx, treatment experience, gaps and myths), self efficacy (skills and self confidence, practice skills), Support network (family and friends, online discussions and resources, advocacy organizations, and HCP team) and their surrounding environment (socio economic factors, family/other personal, their experience with the disease, and access and coverage)
  • A patient journey supports all phases of the brand experience including adherence to act as a frame work to developMessaging platformsConcept developmentTactical development Suggests timing and cadence needs based on patient experiencesBegins with an understanding of the step by step process or “journey” from initial diagnosis to treatment initiation, to successful treatment, including side effect management and adherenceThe journey features the patient pathway, the relevant insights along the way and maps the educational needs of the patient at each critical stepProvides a “snapshot” in timeHelps identify “key leverageable moments” that can be aligned with tactical interventions
  • To find and fill gaps and needs to build successful adherence, the brand needs to identify what experiences all journeys consider:PhysicalEmotionalSocialClinicalEducationSkillsThe treatments that patients have already experienced with brandsInteractions with caregivers and cliniciansBy recognizing this journey- and in particular for this purpose- at adherence behaviors, we can intervene tactically to combat those barriers a patient is anticipated to face while successfully setting them up for adherence, before they even take the first dose.
  • Overall, behavior models – both theoretical and proven- help to provide a framework to identify and ultimately shape or change behaviors. This includes helping to predict an individuals ability to adhere to a treatment regimine and provide tactics to help encourage adherence.
  • There are many different types of behavior change models and many that could fit into a disease state, but there are 3 factors to consider when working with a behavior change model and a brand- 1. The brand objective, 2. The patients experience and 3. the disease state. Evaluating these factors and validating them with clinical research will help provide your brand with a framework for behavior change.
  • The traditional pharma model is broken into 4 stages and tends to be more superficial. We suggest looking at it a little different
  • We can use the HBM to recognize these areas of concern, for example, when first starting a treatment for metastatic melanoma, if the patient doesn’t believe that the condition is serious, that he wont continue to be susceptible to it- then the chances for him being adherent to the treatment are pretty poor. Thankfully- we can provide tactical interventions to help him successfully start treatment- and provide him with the skills, beliefs and attitudes to remain adherent.
  • After establishing patterns, barriers, motivators and key areas of need, we can intervene tactically
  • Brands need to recognize that the clinical encounter involves more than the doctor to patient interaction. Its actually a series of very dynamic relationships and the true clinical encounter takes into account interactions and communication between multiple stakeholders as well as recognizing, and addressing their needs.
  • Patients are often seen as an extension of the marketing experienceIntricate relationships exist between HCP’s and patients and how they interactBy layering a patient journey with the clinical encounter, we can understand the multidimensional dynamics of the healthcare environment and the influencers of patient successNote that some interactions that should be evaluated include those that are NOT so common or top of mind .For example, patient to patient, patient to caregiver, HCP to pharmacist, or the brand to the pharmacist.
  • Layering on these clinical encounters then can tell us more than just the patient experience- rather it can illustrate the dynamic experience between patients, nurses, doctors, support groups, caregivers and other HCP’s- which can then be messaged to.
  • Great deal of reasons for low health literacy -Stress and anxiety (including in the doctors office)-Use of unfamiliar technical languageLearning disabilitiesLack of educational opportunityCognitive ability reduced with ageESLPatients need to be able to find information:On the Internet, andThrough health and advocacy organizations (to request information and support)They must also be able to:Understand treatment choices and recommendationsInterpret descriptions of treatment efficacy and risks for disease recurrence or progression—many of which use numerical concepts such as percentages and probabilityAsk questions for clarificationUnderstand a risk evaluation and mitigation strategies (REMS)–related consent form that describes the possible risks of taking a product In addition, patients should be able to:Interpret charts and labels Decide when to take a medication and what dose to takeKeep track of medications taken and doctor appointments, symptoms, side effects, and progress
  • Although humorous in nature, not too far from what we experience in real life
  • According to the NAAL study, Only 12% of Americans are proficient in health literacy skills.9 out of ten Americans have difficulty using everyday health information to make good healthcare decisions (including medicine choices, taking medicine, and knowing how to take)And low health literacy does not mean low IQWhen they cannot find or understand that information, the healthcare industry also pays the price
  • Our clients recognized the value in making materials health literacy and addressing comprehension issues to help patients move along their journey and stay adherent. In evaluating the materials against the core health literacy principles of content, layout, interaction, and design, we noticed some key weak points- and then (TRANSITION) revised the materials to meet health literacy principles. The layout now includes a lower reading level, more white space, chunked information, dual coding, and interactivity to name a few. It also includes principles from the behavior model such as self-efficacy, cues to action while overcoming adherence barriers.
  • These resources also contain tools such as measurement tools, guidelines, and checklists
  • The patient journeyThe behavioral modelTactical interventions aligned against the model and journeyThe clinical encounterMeasurementThe dynamic relationship of all 5 considerations drive a strong, targeted and effective brand experience that fosters adherence.
  • Key takeaway: brands can drive more effective patient interactions…when they effectively position patients at the center of their adherence strategyTalk with us or other HealthEd attendees to learn more
  • Adherence Begins Before Treatment: EXL Adherence Summit Presentation

    1. 1. Adherence Begins Before Treatment:5 Strategies You Must Consider toDrive Effective Patient InteractionsExL Pharma 2nd Patient Adherence SummitPhiladelphia, PAFebruary 23, 2012
    2. 2. Meet Your Presenters
    3. 3. Marissa Addalia Liz Carden, MPH, CHES Manager, Vice President Health Education ©2012 HealthEd Group, Inc 3
    4. 4. Integrated Insights Drive Our Educational Approach Insights Research Brand Objectives, Strategies, and Plans Clinical, Direct Care Experience Competitive AssessmentsAnalysis and Assessment of Health Literacy andBuying Process Health Clear Communication Segmentation and Education Market Sizing Brand Adult Learning and Behavior Change Theory Strategy Positioning Educational Design Channel Strategies Current Program and Communication Assets/Metrics Online Conversation Mining ©2012 HealthEd Group, Inc 4
    5. 5. Traditional Marketing Focus:How Patients’ and Caregivers’ Lives Fit Into the World of the Brand RX This perspective may not allow programs or content to address real world barriers as patients and caregivers make choices and decisions on how to manage their health. ©2012 HealthEd Group, Inc 5
    6. 6. Our Focus:How the Brand Fits Into Patients’ and Caregivers’ Lives Values, Emotions, Beliefs, and Attitudes Surrounding Knowledge Environment Support Network Self-efficacy ©2012 HealthEd Group, Inc 6
    8. 8. ©2012 HealthEd Group, Inc 8
    9. 9. 1. Map the Patient JourneyWHY?Patient journeys distill insights and translate emotional andenvironmental barriers to wellness into visual, actionable frameworksWHAT?An illustration highlighting:• Phases of the brand and/or disease journey• The patient and care partner experience• Landscape metaphors• Clinical treatment overview• Patients’ relationships with core clinicians• Key leverage points and aligned tactics ©2012 HealthEd Group, Inc 9
    10. 10. Begin by Mining Insights Ethnographies Focus Groups/ IDIs Brand Insights Mining Literature Brand Research Review Research Sources Qualitative Social Media Research Quantitative Research ©2012 HealthEd Group, Inc 10
    11. 11. Insights Inform the Patient Journey ©2012 HealthEd Group, Inc 11
    12. 12. Rheumatoid Arthritis ©2012 HealthEd Group, Inc 12
    13. 13. Hemophilia ©2012 HealthEd Group, Inc 13
    14. 14. Alzheimer’s ©2012 HealthEd Group, Inc 14
    15. 15. SNAPSHOTThe Metastatic Melanoma Patient Journey ©2012 HealthEd Group, Inc 15
    16. 16. ©2012 HealthEd Group, Inc 16
    17. 17. 2. Identify and Execute a Behavior Change ModelBehavior change models explain people’s behaviors–as well as how they can be influenced to change• Identify patterns and how educational programs can influence them• Consider environmental, emotional, social, and behavior characteristics• Expand understanding about barriers and motivators• Allow us to “predict” behaviors when coupled with the journey to set up appropriate interventions ©2012 HealthEd Group, Inc 17
    18. 18. Some of the Validated Behavior Change Models Cognitive Dissonance Health Belief Model Theory Theory of Planned BehaviorTheory of Reasoned Action Social Cognitive Theory Stages of Change Transactional Model of Stress and Coping Horne’s Model of Medication Adherence Health Action Process Approach …and more! ©2012 HealthEd Group, Inc 18
    19. 19. Traditional Pharma Model Awareness Conversion Initiation Adherence ©2012 HealthEd Group, Inc 19
    20. 20. The Health Belief Model Construct Description Perceived The patients believe they are at risk for the susceptibility condition or for the condition getting worse Perceived severity The patients believe the condition is severe and urgent Perceived barriers The patients’ assessment of the influences that discourage the action Perceived benefits The patients’ assessment of the influences that encourage the action Perceived efficacy The patients’ belief that they can adopt the action Cues to action External influences prompting the behavior ©2012 HealthEd Group, Inc 20
    21. 21. SNAPSHOTThe Metastatic Melanoma Patient Journey• Perceived susceptibility• Perceived severity• Perceived barriers• Perceived benefits• Perceived efficacy• Cues to action ©2012 HealthEd Group, Inc 21
    22. 22. SNAPSHOTThe Metastatic Melanoma Patient Journey• Perceived susceptibility• Perceived severity• Perceived barriers• Perceived benefits• Perceived efficacy• Cues to action ©2012 HealthEd Group, Inc 22
    23. 23. ©2012 HealthEd Group, Inc 23
    24. 24. 3. Understand the Clinical Encounter The multidimensional dynamics of the healthcare environment and the influencers of patient success ©2012 HealthEd Group, Inc 24
    25. 25. Recognize the Domino Effect ©2012 HealthEd Group, Inc 25 25
    26. 26. SNAPSHOTThe Metastatic Melanoma Patient Journey ©2012 HealthEd Group, Inc 26
    27. 27. ©2012 HealthEd Group, Inc 27
    28. 28. 4. Measure Patient BehaviorFocus on showing a measurable incremental positive impact • Change in skills • Change in knowledge • Change in attitudes and behavior model metrics • Change in behavioral intention ACTIVELY ACTIVELY DISENGAGED ENGAGED ©2012 HealthEd Group, Inc 28
    29. 29. Where to Find Measurement Opportunities Behavioral Skills Knowledge Attitudes Intention• Enriching doctor-patient • Increasing patients’ • Increasing patients’ • Driving patients to communication knowledge about their perceived benefit of specific calls to action• Improving patients’ disease and skills to cope treatment and (e.g., join support ability to understand and with their treatment understanding of the program, refill script, follow treatment routine reasons why medication make an appointment is needed with HCP) • Increasing patients’ • Increasing patients’ motivation to begin and intent to follow medical stay on treatment routine • Setting patients’ expectations about treatment • Increasing patients’ confidence in their ability to follow treatment regimen • Reducing fear of possible side effects • Reducing feelings of stigma because of the disease ©2012 HealthEd Group, Inc 29
    30. 30. SNAPSHOTThe Metastatic Melanoma Patient Journey ©2012 HealthEd Group, Inc 30
    31. 31. ©2012 HealthEd Group, Inc 31
    32. 32. 5. Incorporate Health LiteracyMore Than Reading Health-Related Information Health literacy is defined as: The ability to find, understand, and use basic health information and services needed to make appropriate health decisionsWithin healthcare, patients require health literacy skills to: • Find health information • Interact with healthcare providers (HCPs)They also need the skills to: • Self-manage a health condition • Navigate the healthcare system ©2012 HealthEd Group, Inc 32
    33. 33. Low Health Literacy: An Example ©2012 HealthEd Group, Inc 33
    34. 34. The Impact of Low Health Literacy 90 million Americans are at risk for not acting on health information because of low health literacy, regardless of age, income, race, or background The cost of limited health literacy to the nation’s economy is estimated to be between$106 billion and $236 billion per year1. Weiss BD. Health Literacy and Patient Safety: Help Patients Understand. 2nd ed. American Medical Association; 2007.2. Vernon JA et al. 2007. Low Health Literacy: Implications for National Health Policy.; 2007. ©2012 HealthEd Group, Inc. 34
    35. 35. Why Utilize Health Literacy Principles? • Better comprehension = greater adherence • Greater financial impact • Required by governing bodies ©2012 HealthEd Group, Inc 35
    36. 36. Skin Care – Before/After ©2012 HealthEd Group, Inc 36
    37. 37. Using Health Literacy Principles to Improve Response Rates Challenge: Approach: To help increase enrollment in its IDPH simplified the language of the Brain Injury Registry, the Iowa letter and adjusted the content to Department of Public Health (IDPH) reflect patients’ perspectives Brain Injury Services promoted its services to Iowans with a recent brain injury 4% Response Rate 15% Response Rate ©2012 HealthEd Group, Inc 37
    38. 38. Health Literacy Resources Centers for Disease Control* Clear Health Communication Health Resources and Service Administration* US Department of Health and Human Services Health Literacy Missouri Florida Literacy Coalition A resource library of health literacy resources is also available at SurroundHealth®. Visit*Denotes free training available ©2012 HealthEd Group, Inc 38
    39. 39. Summary
    40. 40. Pulling It All Together c c ©2012 HealthEd Group, Inc 40
    41. 41. 5 Strategies to Drive Effective Patient Interactions 1. 2. 3. 4. 5. Map Identify Understand Measure Incorporate the patient & execute a the clinical encounter patient behavior Health Literacy journey behavior change model ©2012 HealthEd Group, Inc 41
    42. 42. Thank You! Liz Carden, MPH, CHES For More Information, Please Contact: Marissa Addalia Vice President 908-379-2018