Doctors have probably been telling people to ‘keep taking the tablets’ since the earliest shamans and folk healers were first frustrated by the non-compliance of their prehistoric patients.
Today, the pharmaceutical industry is leaving an estimated US$25 billion on the shelf every year through lack of patient compliance. Events like eyeforpharma’s conference, Patient Compliance Europe, now in its third year, reflect a growing recognition of the importance of patient compliance and its impact on revenues.
Current estimates put non-compliance possibly as high as 50-70%. This is despite the well-known fact that poor compliance is associated with a lower quality of life, poor clinical outcomes, increased hospitalisations and higher overall healthcare costs. Clearly, compliance is actually synonymous with patient well-being.
So, why do people stop taking the pills? The conference drew a key distinction between types of non-compliance. There is intentional non-compliance, where patients choose not to comply with a medical regimen, reflected in unfilled prescriptions or filled prescriptions not taken, or where patients refuse treatment. And then there is unintentional compliance, where patients don’t understand the appropriate use of medicines, take them at the wrong time or the wrong dose, don’t understand the instructions or simply forget.
There are a whole range of influencing factors at work behind non-compliance. One set of factors is the patient’s general health beliefs (e.g. 'medication is dangerous', 'I will get better on my own', 'invasive or aggressive therapy is not worth it' and 'new medicines are better than old ones'). These are underpinned by the patient’s general social and economic characteristics, such as age, educational level, self-rated health (‘I feel OK so I stopped taking the tablets’), cultural and religious beliefs and, importantly, what friends and partners think about the medicines.
Addressing compliance issues means understanding consumer behaviour. How does the consumer perceive his/her problem? How bothered are they by it? What is motivating the non-compliant behaviour? What are the barriers to compliance? And what is the patient-physician dynamic?
CONTENTS
Patient Compliance Europe - Programme
Introduction
About the author
Reasons for non-compliance
Implementing a compliance programme
Terminology and techniques for improving compliance
Who is responsible for compliance, and who pays?
Routes for providing valuable information
The obstacle of regulation
Tools and technologies
Which channel, what time?
The patient and adherence programmes
Who ‘owns’ the compliance programme?
Are pharmacists the answer?
Workshops
Conclusions
References
ABOUT THE AUTHOR
John Hosken has been closely involved in writing about, planning and implementing technology for the pharmaceutical industry for the past decade. After a career in financial and consultancy marketing, he joined Merck in 1997 as one of the pharmaceutical industry’s first internet strategy managers. He helped the company to get involved in using the web to market to doctors in a wide range of countries, moving to Acurian to develop its franchise in the clinical trials online recruitment market, and then held a range of pharmaceutical marketing posts in agencies. He has been writing on pharmaceutical marketing and technology topics for Pharmafocus since 2002, and recently contributed another in-depth report from an eyeforpharma conference (held in Barcelona, 14-15 March 2006) to the Conference Insights series, entitled Mobile and Wireless Sales Force Strategies (kwp007).
Patient non-compliance is an expensive and widespread problem for the pharmaceutical industry. With rates of non-compliance sometimes as high as 70 per cent, drug companies are losing around $25 billion each year simply through patients not taking their medicine. The impact on clinical outcomes, public health and healthcare costs is severe.
The Patient Compliance Europe Conference, organised by eyeforpharma and held in Amsterdam on 1-2 June 2006, explored the major issues surrounding patient compliance, showcasing research and case studies from major European pharmaceutical companies and how they are addressing the problem.
This Conference Insights review outlines the most pertinent issues from selected presentations at the event. It examines the most common reasons for patient noncompliance and looks at methods to combat them. It offers advice and guidance on how to implement a successful compliance programme, based on real market experiences.
The issue of who has ‘ownership’ of compliance is discussed: is it the responsibility of the brand manager, medical affairs or senior management? And who should play the role of educator: the doctor, the pharmacist, the nurse or the drug company?
The report finds that the overall responsibility lies with the pharmaceutical industry, which - public health aside - also stands to benefit most from an increase in compliance. Yet, despite a growing armoury of tools with which to educate patients on the value of medicine, a general apathy to tackle the issue head-on pervades the pharmaceutical industry. Despite conference rhetoric to the contrary, the industry doesn’t regard compliance as a major issue. And the smart brand manager who introduces a compliance programme will be elsewhere in the industry by the time its long-term impacts are realised.
CONFERENCE PROGRAMME
Chairperson: Mike Rea, CEO, IdeaPharma
DAY ONE
How patient compliance is increasingly becoming an integral part of the pharma business across Europe Patricia Stenger, Director, Scientific Affairs, Bayer Healthcare
From development to implementation of an effective compliance programme: Lessons learned Brigitte Schau, Manager Value Added Services, Boehringer Ingelheim GmbH
A new business model for the pharma industry - learn how to increase your revenues and profitability from improved persistence and compliance Bernard Vrijens, Chief Scientist, Pharmionic Systems Ltd
The future belongs to branded compliance management Dr Roman Rittweger, Managing Partner, Advisors in Healthcare
Panel Debate: Patient compliance: who’s responsible and who pays? Patricia Stenger, Director, Scientific Affairs, Bayer Healthcare Alex Wyke, Chief Executive, PatientView Helmut Hildebrandt, Chairman, Hildebrandt GesundheitsConsult GmbH
Understanding regulation across Europe. What can pharma companies actually do in terms of patient communication? Alex Wyke, Chief Executive, PatientView
How to integrate mobile and web based programmes to drive better patient adherence to your products Stephan Kerkojus, Group Product Manager, Stallergenes Tanja Antwerpes, Board Member, Antwerpes & Partner
The use of interactive voice response and interactive web response in disease management and compliance programmes Bill Byrom, Product Strategy Director, ClinPhone
Extended Panel Debate: 'Right channelling' - how to decide which marketing channels work best for which patients Moderator: Jay Bolling, Managing Partner, Roska Direct Panellists: Len Starnes, Head European E-Business, Schering AG Di Stafford, Director, The Patient Practice (former Head of Patient Relationship Marketing, Pfizer UK) Yvonne van der Schouw, Patient Relations Manager, Abbott Michel Dubery, Partner, Rapp Collins Consumer Health Dr Antje-Henriette Fink-Wagner, Manager Professional Relations, Global Franchise Respiratory, Altana Pharma AG
DAY TWO
Why improving your packaging is the key to improving your patient adherence Tassilo Korab, Executive Director, HCPC (Healthcare Compliance Packaging Council)
How to benchmark patient compliance and set realistic targets for your programmes Led by: Len Starnes, Head European E-Business, Schering AG
How to measure patient compliance and calculate real ROI Led by: Jay Bolling, Managing Partner, Roska Direct
Patient education and links to patient compliance. How to ensure you get your information right Led by: David Bertholon, Patient Relations Manager, Schering Plough
The future of patient compliance in Europe - where do we go from here? Led by: Di Stafford, Director, The Patient Practice (former Head of Patient Relationship Marketing, Pfi zer UK)
The role of pharmacies in patient compliance. Are pharma companies missing a trick in not utilising the high street channel to better effect? Led by: Nathan Branch, Head of Services, Alliance UniChem Plc
Panel Debate: Thinking inside the box! The best ways to ensure you get your packaging right Thomas R Grinnan, Director, Healthcare Packaging Europe, MeadWestvaco Corporation Tassilo Korab, Executive Director, HCPC (Healthcare Compliance Packaging Council) Bernard Bousquet, Development Director, ABR Pharma Compliance? Adherence? What does the patient want? Nick Hicks, European MS Platform, External Consultant
Panel Debate: Which disciplines in your business need to come together to guarantee effective delivery of compliance programmes? David Bertholon, Patient Relations Manager, Schering Plough Di Stafford, Director, The Patient Practice (former Head of Patient Relationship Marketing, Pfizer UK) Søren E Skovlund, Senior Adviser, Stakeholder Relations, Novo Nordisk How to measure ROI and deliver a business case for patient compliance Mark Nuijten, Health Care Management, Erasmus University
Joined up thinking. How collaboration with key stakeholder groups can open up new areas of opportunity in patient compliance Adrienne van Strien, Manager Pharmaceutical Healthcare, GSK, Netherlands Rebecca Bloor, Healthcare Development Manager, Wyeth Pharmaceuticals Helmut Hildebrandt, Chairman, Hildebrandt GesundheitsConsult GmbH
Future Perspectives: A recap of key learnings from the conference and perspectives on what the future holds for patient compliance in Europe Chaired by: Mike Rea, CEO, IdeaPharma
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