This project has received funding from the European Union’s 7th Framework Programme for research, technological development and demonstration under grant agreement no 611709
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> Affordable, effective and scalable solutions for treatment adherence
Type proposer: GET consortium
Adherence to treatment is the degree of overlap between the behavior of the patients and the recommendations of health professionals regarding medication intake and changes in diet and lifestyle (Sackett and Haynes definition*). It was also known as Medication Compliance, and is part of the wider concept of Medication Optimization.
It is estimated that, in general, one third of patients do not use the medication as recommended by their doctor, and another 30% only does it sometimes. Ten days after starting a medicine, almost a third of patients are already non-adherent – of these 55% don’t realise they are not taking their medicines correctly, whilst 45% are intentionally non-adherent**. Adherence to longterm treatment is around 50% in developed countries according to a World Health Organization (WHO) report.
A report published by IMS Health reveals that the misuse of drugs causes about 8% of health spending in the world, and 57% of them corresponds to non-adherence. According to calculations of the Spanish Therapeutic Adherence Observatory (OAT), non-adherence to drug treatments yearly causes 200.000 premature deaths in Europe, with an estimated cost of 125.000 Million euros to the Healthcare systems. At a global level, the New England Healthcare Institute estimates that $290 billion of healthcare expenditures could be avoided if medication adherence were improved.
Increasing treatment adherence is a win for all actors:
Why patients do not adhere to their pill regimen and other therapies (eg. use of inhalers)? There is not a generic answer, each person has his or her own set of complex and interrelated reasons. Deep reasons are heavily dependent on psychological factors, and management of behavioural change is required to obtain lasting outcomes.
Due to the human factors involved, improving treatment adherence is a complex issue that usually cannot be addressed with generic solutions (eg. medication reminders) especially to those with long term conditions. Medication adherence can be especially difficult for older adults. Physical, cognitive, and sensory health often decline with age. Mobility difficulties, forgetfulness, and diminished sight and hearing make it more difficult to acquire medications, understand instructions, remember to take medications on time, and read and hear medication-taking instructions. Because medication adherence is considered an instrumental activity of daily living, the ability to manage medications successfully is an important factor in maintaining independence in the older adult population***.
* Sackett DL, Haynes RB, Gibson ES, Hackett BC, Taylor PW, Roberts RS. Randomised clinical trial of strategies for improving medication compliance in primary hypertension. The Lancet 1975;1:1205-7.
** N Barber, J Parsons, S Clifford, R Darracott, R Horne. Patients’ problems with new medication for chronic conditions. Qual Saf Health Care 2004; 13: 172-175. http://qualitysafety.bmj.com/search?author1=R+Horne&sortspec=date&submit=Submit
*** Hayes BD, Klein-Schwartz W, Gonzales LF. Causes of therapeutic errors in older adults: evaluation of National Poison Center data. J Am Geriatr Soc. Apr 2009;57(4):653-658.
> The need
Affordable, effective and scalable solutions that act on the causes of non-adherence and provide comprehensive support, especially to chronic and older patients
In order to maximize lasting impact, not only on the intentional factors should be addressed (medication intake, management of side effects, use of devices), but solutions should also cope with
non-intentional factors (beliefs, habits, lifestyle, relationship with the physician).
Key components towards the optimal use of therapies and self-management of disease may include: patient engagement, behaviour change, facilitation of clinician/patient communication, multichannel contact and family/carer involvement.
There may be also different strategies and approaches depending on several characteristic: type of disease, years with condition, familiarity with technology, etc. For example, depending on the type of disease it is not the same if the consequences of non-adherence are noticeable in the short term and patients frequent visits to their doctors, compared with, for example, patients of glaucoma, where the effects are not noticeable in the day to day and visits are not frequent.
Due to the different factors involved, it may be wise for the entrepreneurs to set up multidisciplinary teams that not only incorporate ICT developers, but also experts in psychology and behaviour change.
> Let's not reinvent the wheel...
With the popularization of mobile phones, what the authors consider a 1st generation of mobile solutions (especially in the form of Apps), have been made available to the general public. The solutions, some of them developed by Pharmaceutical companies, go from simple medication reminders to incorporate gamification or the use of wearables. There are also devices like Medication Dispensing Services, smart pill boxes and trackers of inhaled medication.
We present below a non-exhaustive selection of them for illustration and reference purposes:
Do you want to include your reference here? Contact us!
> The challenge
Despite the solutions above, the GET project consortium still considers that there is a major business opportunity in the area of Medication Adherence and Medicine Optimization, specially taking into account the magnitude of the problem, both in health and economic in terms. The aging of population, with its related increase of chronic conditions and multi-morbidities, would only worsen the current figures.
The GET partners believe that we are only at the beginning of the wide-spread use of cost-effective, scalable and personalized solutions to improve adherence with the support of digital technologies. Therefore we would like to draw attention, and support the development of innovative and profitable initiatives on this area. Patient uptake is key, but healthcare professionals are also fundamental, and they need to be engaged, motivated and trained.
Like other topics in Health though, not only human factors are challenging. It is also critical to properly address business models and the wide-spread adoption by (older) patients, clinicians and the healthcare system in general. However, compared with other Health needs, the interest of Pharmaceutical laboratories and pharmacies in the problem may facilitate the deployment of new commercialization strategies for the benefit of all actors.
Finally, it is not paramount to solve all situations with a single solution. Different approaches and technologies shall work best depending on the type of disease, years with condition, or familiarity with technology. Do not get overwhelmed by the challenge, fragment it and pick your best bit.
We suggest entrepreneurs should first identify a concrete market segment (eg. by disease or patient characterization), set up a multi-disciplinary team and co-create with patients. For Business Model optimization, you may want to consider Lean Startup, eHIX6 or other methodologies.
Work on this challenge!
Health organisations across Europe are looking for innovative solutions to solve their needs. However, they don't know your solution exists, and they don't know that your exact solution can help solve their exact needs, but that's where we can help you.
If you have a solution or you want to work on this challenge, let us know!