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Patient Adherence: The Next Frontier in Patient Care - Key findings from Capgemini’s latest Vision & Reality research


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Lack of patient adherence to prescribed medications poses a tremendous challenge to the global healthcare community. Bridging the adherence gap is a ‘must do’ for pharmaceutical companies to protect …

Lack of patient adherence to prescribed medications poses a tremendous challenge to the global healthcare community. Bridging the adherence gap is a ‘must do’ for pharmaceutical companies to protect their top line while transforming themselves from product to patient-centric organizations.

This is the result of a Capgemini Consulting research across Europe and the United States. The aim of the research was to understand the root causes of non-adherence, how the industry has addressed non-adherence in the past and what an innovative approach should look like.

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  • First of all, it is important to agree on the meaning of the word “adherence”. Patient adherence is most commonly defined as compliance (that is to say taking a treatment as prescribed) and persistence (that is to say consistently taking a treatment over a period of time). It also implies an increased role of the patient in his own treatment.This is the definition that we will use across our study.
  • Adherence rates across most therapeutic areas are very low – only about 50% of patients take medications as prescribed. Our survey shows that patients drop off at different points of time on treatment. About a third of patients don’t even fill the prescription in the first place. When they do fill it, they tend to stop refilling after a few months. Therefore after 6 months, only about 43% of people continue to refill their prescriptions.
  • In order to understand the current industry state for patient adherence, we analyzed 3 areas:First, we tried to understand the reasons why patients don’t adhere to treatment. We found that these reasons are related to the patient and his behavior, but also to the characteristics of the disease, the treatment and the access to treatment in the healthcare system.Then we looked at influencers of patient behavior, and we found that adherence is not a top priority for most stakeholders - for example, physicians are a major influencer but seldom have time to educate patients on the importance of adherence.Finally, we looked at existing initiatives to improve adherence. We found that most of them had limited impact on patient behaviors, because they were isolated tactics that lacked consistency and failed to efficiently address patient needs.
  • As an example illustrating our findings, let’s look at the factors for non-adherence.Most interviewees agree that non-adherence is mainly due to the patients’ lack of understanding of disease and treatment, which causes them to have a wrong attitude. Patients are not aware of the importance of adherence and are forgetful. As a result, they abandon treatment if they don’t see improvement, or on the contrary if they feel better.The second most important set of factors is related to the treatment itself: patients drop off because of side-effects or because the administration of drug is too cumbersome for their lifestyle.For more details on our findings, please refer to our report.
  • Looking at the current state, we have seen that adherence improvement has not been a priority for the industry. However looking forward, we expect many things to change: we have seen 4 levers that will likely increase focus on patient adherence improvement.The first lever is related to the involvement of different stakeholders. Their roles will change: for example, payers are likely to get involved, linking adherence to reimbursement levels. Besides, our interviewees expect more collaboration between providers, pharma, payers and patients.The second lever is related to healthcare reforms. For example, reforms on payment in the US shift from fee-for-service to outcome-based incentives and will encourage providers to work towards improved patient adherence.The third lever is the digital health media such as specialized online forums and patient communities. These media will enable all stakeholders to better keep in touch with patients, with better chances of influencing their behavior.The fourth and last lever we identified is related to different technology advancements, that offer additional adherence improvement tools - such as smart packaging or remote patient monitoring.
  • However, beyond isolated tactics, pharmas need a more consistent approach to patient adherence in order to maximize their impact by creating a entirely new patient experience.First of all, they need to make adherence a key pillar of marketing and sales efforts. Adherence should be taken into account early in development to influence product features. All patient leakages should be reviewed thoroughly to identify opportunities. The analysis should be comprehensive, and go beyond the levers that pharma can utilize directly, to include relevant influence points from all healthcare stakeholders. The impact of all patient touch points must be maximized in an economical way: this will require companies to understand which patients represent the highest value for their adherence programs.Finally Pharma has to make sure that it is enriching the quality of life of the patients while gathering continuous feedback from them to improve its efforts. We explore each step of this framework in more detail in our report.
  • Transcript

    • 1. Vision & Reality 9th EditionPatient Adherence: The Next Frontier in Patient CareMay 2011
    • 2. Vision & Reality is Capgemini Consulting’s 9th annual thought leadership publication for the Life Sciences industry
      Each year Capgemini Consulting
      examines a topic critical to the life sciences industry…
      This year we have focused on the issue of patients’ adherence to medication
      • We conducted 66 one-on-one interviews with Life Sciences executives
      Sector Representation
      • Pharmaceutical/Biotech companies: 49
      • 3. Payers: 7
      • 4. Pharmacists: 4
      • 5. Others1: 6
      Geographic Representation
      • North America: 48
      • 6. Europe: 18
      • 7. Including: France, Denmark, Germany, Netherlands, Portugal, UK, Spain and Switzerland.
      • 8. Additionally, secondary research was conducted by Capgemini’s Life Sciences Strategy Lab
      Note: (1) Others include Patient Advocacy Groups, Academic centres and a healthcare consulting group
      Copyright © 2011 Capgemini Consulting. All rights reserved.
    • 9. What is patient adherence?
      Adherence is defined as taking a treatment as prescribed (compliance) AND over the prescribed period of time (persistence)
      • Extent to which a patient follows a prescribed treatment
      • 10. Extent to which a patient follows a prescribed treatment plan agreed on with the physician
      • 11. Adherence implies a more collaborative relationship between patients and clinicians and is more respectful of the role of patients in their own treatment
      • Extent to which a patient consistently continues treatment over a period of time
      Source: (1) The Free Dictionary - 2) Datamonitor: Disease Management and Drug Adherence, 06-2007
      Copyright © 2011 Capgemini Consulting. All rights reserved.
    • 12. 9
      Only about 50% of patients take medications as prescribed and there is a sharp drop in adherence over time on treatment
      Adherence rates across the duration of therapy
      Adherence rates of select
      conditions in US, 20081
      Adherence rates to prescribed medicines estimated by respondents2
      Source: (1) Andree Bates, “Ensuring Profitable Patient Adherence Programs”, Eularis, March 2010 (2) Source: Capgemini external interviews - Q2) What in your opinion is the current level of adherence in patients?
      Copyright © 2011 Capgemini Consulting. All rights reserved.
    • 13. We analyzed factors of non-adherence, influencers of patient behaviors, and interventions to improve adherence
      Dimensions of
      Patient Adherence
      Source: Capgemini analysis
      Copyright © 2011 Capgemini Consulting. All rights reserved.
    • 14. Across all respondent groups, patient attitude and therapy complexity were identified as main factors of non-adherence
      Average rating of factors
      driving adherence across
      respondent groups
      Q4) Could you please prioritize the most dominant factors and also identify the top 3 stakeholders who can influence these factors?
      Source: Capgemini external interviews
      Copyright © 2011 Capgemini Consulting. All rights reserved.
    • 15. But things are changing and focus on patient adherence improvement will increase
      Healthcare Reforms
      Healthcare Industry Involvement and Collaboration
      Levers to Improve Adherence
      Digital Health Media
      Technology Advancements
      Copyright © 2011 Capgemini Consulting. All rights reserved.
    • 16. Going forward, we recommend companies adopt a comprehensive and coherent framework to address patient adherence
      Source: Capgemini analysis
      Copyright © 2011 Capgemini Consulting. All rights reserved.
    • 17.