Non-adherence is the norm- Legalize it!

“Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any other improvement in specific medical treatments”

Haynes RB. Interventions for helping patients to follow prescriptions for medications.

Cochrane Database of Systematic Reviews, 2001, Issue 1.

... or lower depending on country“Adherence to long term therapy”, WHO 2003

Poor adherence to treatment of chronic diseases is a worldwide problem of striking magnitude

50%

Self-regulation: Grasshopper vs. ant

Source: Self-regulation model, Leventhal et al. 1984

Beliefs drive behavior

Time

Control/Cure

Causes

Identity

Consequences

Source: Illness perception model, J. Weinman et all 1995

Resisting medicines

Overuse

HarmNecessity

Concerns

So does the Internet impact adherence?

We asked 200 patients in HealthUnlocked Lupus community how they felt about adherence

About 60% admitted to having missed doses

...mostly because said because they forgot

...few admitted because of side effects

I stopped, because I wanted to know how I feel without med.

The drugs have lots of side effects and sometimes i just don’t want to take them...so I forget

Just felt completely fed up and couldn't be bothered. Medication doesn't really make me feel much better.

Scared by the thought that this is my future and then find out that most people think it is an inevitable ...

Going deeper though some deeper motives emerged

Online engagement made patients feel better informed and consequently more confident

...which in turn had an effect on their adherence

It makes you think about the consequences of taking them

when you read about some of the side effects that people suffer from.

It made me question drug regime more.

Information

Skills

I was able to negotiate the change with my NHS Endo after a year on no meds. I now take in split doses. I am doing well.

Gives me confidence to hear that people have the same experiences

MotivationIt's the support you get and

the motivation and they understand what you are going through.

It helps me stick with my meds despite the side effects reading what other people have to put up with.

Change

That people tend to explain their experiences this has led me into trusting the meds a little bit more.

It encouraged me to wait for the tablets to take effect.

15

Internet creates mostly POSITIVE change

Information + Motivation + Skill= Behavioral Change

Info

Skill

Motivation Change+ + =

Change

Reinforcement

Relapse prevention and recuperation

17

How can Multi Channel Marketing help?

Disease awareness

Patient information and education

Content

Product necessity and safety

Tools

Self Monitoring

Behavioral strategies

Goal setting

Feedback

ConversationCommitment

Behavioral contracting

Social Support

Payors “get it”: Non-adherence comes at a cost

Source: Medication Adherence Leads to Lower Healthcare Use and Costs Despite Increased Drug Spending, Health Affaires, 2011

Payors believe digital is part of the solution

Products lie to us. Food says "low carb" or "sugar-free," but isn't good for us. Nutritional information isn't always accurate, or has unrealistic serving sizes.

Companies and gadgets lie. We're told something makes diabetes "easy" or "painless." Diabetes is never easy, and never painless.  

My insulin pump is the best piece of technology I've ever had, but it sometimes lies to me too. Sometimes it says it's delivering fine, but the cannula is kinked so my sugars are suddenly in the 20s with no explanation? I never know. How much of the insulin did I actually get?

Diaturgy blog

Are we letting our patients down?

Are we expecting patients to behave according to unrealistic standards we made up in labs?

Non-adherence is nothing new

Non-adherence is the norm- Legalize it!

but our definition of adherence is old

Patient empowerment is risingand the internet is the elevator

Need to transform adherence guidelinesinto real world health outcomes

Patients need to be supported not blamed“Adherence to long term therapy”, WHO 2003

Self-Regulation-Experiment: social vs. hangover