The document discusses factors that influence patient adherence to medical treatment plans. It notes that around a third of prescriptions are never filled and compliance rates are low even for prescriptions that are picked up. Barriers to adherence include lack of knowledge about diseases and medications, concerns about side effects and costs, and lack of motivation. The document advocates for addressing these barriers by providing personalized messages that create motivation, ensuring patients comprehend their conditions and treatments, and identifying what specific issues cause non-adherence for individual patients. Digital tools should be designed using these behavioral principles to increase long-term engagement.

2. TALYA MIRON-SHATZ, PH.D. University of Pennsylvania

3. The (missing) Human Factor in Advanced Technology Talya Miron-Shatz, Ph.D. CEO, co-founder, CureMyWay ePatient Connections – Philadelphia – September 21st, 2011

4. Talya Miron-Shatz, Phd. talya@CureMyWay.com Cure MyWay Personalized Adherence Solutions

5. What makes us stick with anything digital? Knowing it’s important? Fun Immediate reward Accomplishment

6. An analogy: digital technology and adherence to medication Pete Fader’s persistency curve

7. Extent and cost of drop-out: not picking up prescriptions; failing to follow orders. Talya Miron Shatz PhD talyam@wharton.upenn.edu The actual number of prescriptions filed in a year ranges from 1.5-2.0 billion. 1,2 A value of 1.75 billion was taken for the figure above. In Billions of Prescriptions A third of prescriptions do not even make it to the pharmacis t. 2 Although in some cases these prescriptions are not vital (i.e. pain-killers that the patient can pick up as needed), the figure is nonetheless alarming. Even when prescriptions are picked up, compliance rates are still no where near perfect as seen in the lower bar graph.

8. Why, oh, why? The Adherence Estimator Colleen A. McHorney, U.S. Outcomes Research, Merck 88% of patients at risk of middle to high non-adherence are concerned over: Medication (side effects, safety) knowledge Disease (is it trivial? OR can it actually be cured/better). knowledge + motivation Affordability. Talya Miron Shatz PhD [email_address]

9. 1. Making sure ‘doing the right thing’ feels good vs. bland What is ‘the right thing’? Talya Miron Shatz PhD [email_address]

10. Do patients get it? Are they supposed to?

11. Talya Miron Shatz PhD [email_address] Result for 2D6 Intermediate Metabolizer DNA Direct genotype: *1/*5 The results of your test indicate that you are an Intermediate Metabolizer for 2D6. People who are Intermediate Metabolizers have one 2D6 gene that produces functioning enzymes, and one 2D6 gene that does not. Intermediate Metabolizers may not metabolize certain drugs as quickly or fully as Extensive Metabolizers (normal). However, studies show that Intermediate Metabolizers maintain enough metabolism to receive medical benefit from tamoxifen, similar to patients who have two 2D6 genes that produce fully functioning enzymes. Knowing that you are a 2D6 Intermediate Metabolizer can help you and your doctor evaluate your adjuvant hormonal therapy options.

12. Talya Miron Shatz PhD [email_address]

13. The exact way Cymbalta works in people is unknown . Watch how Cymbalta is believed to increase the activity of chemicals in the brain and spinal cord. Understanding Depression Major depressive disorder (depression) is not just a temporary mood, and it's not a sign of personal weakness. Depression is a serious medical condition with a variety of symptoms. Emotional symptoms can include sadness, loss of interest in things you once enjoyed, feelings of guilt or worthlessness, restlessness, and trouble concentrating or making decisions. Physical symptoms can include fatigue, lack of energy, and changes in weight or sleep patterns. Additional symptoms of depression may include irritability, anxiety, and thoughts of death or suicide. There are many theories about the cause of depression. One common theory is that depression is caused by an imbalance of naturally occurring substances in the brain and spinal cord.

14. The Beta Blocker Enigma What has the beta ever done to us and why do we need to block it? Talya Miron Shatz PhD [email_address]

15. Information overload anyone?

16. Self explanatory? To whom? 90 MILLION Americans are of low health literacy – read below a 6 th grader level. No comprehension – no motivation… Talya Miron Shatz PhD [email_address]

17. The Mystery of NYC’s Empire Hotel Shower: What you don’t know your clients don’t know Talya Miron Shatz PhD [email_address]

18. However – information is not enough Does she not know it’s bad for her? Talya Miron Shatz PhD [email_address]

19. Making sure ‘doing the right thing’ feels good vs. bland How to make health –related digital use inherently rewarding? Talya Miron Shatz PhD [email_address]

20. Internal Motivation + Inherent Reward developed by Dr. Margaret Morris, Intel Talya Miron Shatz PhD [email_address]

21. S2H: Being rewarded for offline behavior Talya Miron Shatz PhD [email_address]

22. Or for the real thing Talya Miron Shatz PhD [email_address]

23. Combining knowledge with motivation My new project with an HMO: online interventions for non-adherent statin patients Talya Miron Shatz PhD [email_address]

24. A coherent picture of ‘the right thing’: Health scorecard ( Talya Miron-Shatz with Scott Ratzan, J&J ) Talya Miron Shatz PhD [email_address]

25. And sometimes – making doing the wrong thing feel bad The case of the disappearing friends ( Dr. Morris, Intel ) 3D helmets Talya Miron Shatz PhD talyam@wharton.upenn.edu

26. 2. Creating motivation through personalized messages Talya Miron Shatz PhD [email_address]

27. What creates Motivation Edelman Health Engagement Barometer, 2010. Validated through 15,257 participants 18+. Talya Miron Shatz PhD [email_address]

28. Talya Miron Shatz PhD talyam@wharton.upenn.edu

29. My doctor knows me as a person In a study of 1743 HIV patients: patients who reported that “ my doctor knows me as a person ” were more likely to be adherent to HAART therapy. These results hold when you control for patient age, sex, health beliefs, social stress, and more. Talya Miron Shatz PhD [email_address]

30. First, use their first name Studies on smoking cessation show that personalization through tailoring messages to match one’s sex and other characteristics (e.g., how many cigarettes they smoke, whether they’re married, how many kids they have) increased success of cessation by 35%. This persisted after 6 months. Talya Miron Shatz PhD [email_address]

31. Talya Miron Shatz PhD [email_address]

32. 3.Addressing what really hurts the patient – go figure what this is Talya Miron Shatz PhD [email_address]

33. The conundrum of non-adherence to FDA recommendations Why some parents did not adhere to the FDA warning regarding OTC cough and cold medication? Talya Miron Shatz PhD [email_address]

34. Experience = Immunity to Warning (Miron-Shatz, Barron, Hanoch, Gummerum, & Doniger, 2010). 53.3% of ‘new’ parents adhered but only 28.4% of experienced ones. The FDA sent out the same message… Talya Miron Shatz PhD [email_address]

35. A successful digital blood sugar level measurement tool Why do patients desert? I am conducting behavioral analytic research to find out. Talya Miron Shatz PhD [email_address]

36. CureMyWay’s UDA ™ solution: Takeaways for developers Ensure comprehension Increase motivation through rewards and personalization Explore what it is that users are seeking and perhaps not finding Just like adherence interventions – the good digital health tools are complex… Talya Miron Shatz PhD [email_address]

37. Thank you! Talya Miron-Shatz, PhD. CEO, co-founder, CureMyWay [email_address]