Facing an Adherence and Compliance Gap

Peter J. Pitts

There are no magic bullets in the fight to improve adherence and compliance. What we really need are solutions that impact social conditioning and address patient responsibility, and that means using social media - specifically, apps.

This article published with permission from The Burrill Report.

I’ve just returned from the speaker’s podium at the Optimizing Pharmaceutical Patient Adherence conference. There’s a lot to be done. There are a lot of good ideas. There seems to be a lot of commitment. The better angels of our nature were on display. Now it’s time for action.

The first thing to do is admit is that we can’t relegate the conversation to health care policy. While the conversations are fascinating — another white paper, another committee, another conference — talk isn’t going to move the needle. We need to act.

As I see it, there are six linked issues we are trying to impact:

1. Sub-optimal patient outcomes

2. Sub-optimal physician pay-for-performance metrics

3. Lower health care costs for payers: Not surprisingly, all of the big private payers are in the adherence and compliance game with both feet.

4. Sub-optimal profits for pharmaceutical companies

5. Impact on safe-use: The way to make drugs “safer” is to ensure they are used appropriately. Safe use begins with adherence and compliance.

6. Lower health care costs for society

Alas, there are no magic bullets in the fight to improve adherence and compliance. News articles feature talking pillboxes that offer bells and whistles, rings, buzzes and flashes. That’s all to the good, but they only combat forgetfulness. That is part of the solution, but it’s only a piece of the puzzle.

Some think that the FDA should insist that new drugs have adherence and compliance plans that can be monitored and improved through iterative learning. Should sales reps detail adherence and compliance programs and share validated tools for adherence and compliance triage? The only thing that’s currently on the table is that the FDA has promised to make MedGuides more user-friendly. We can do better.

Others talk about behavior modification through gamification — and that too is a useful pathway. We talk about carrots — but what about sticks to address bad patient behavior — particularly sticks of the financial variety?

All of these are important. But to really make a difference and change the game, what we really need are solutions that impact social conditioning and address patient responsibility — and that means using innovative platforms such as social media and, specifically, apps.

Not apps that are medical devices, but apps that remind, cajole, educate, praise, incentivize and assist patients in their quest for better health. Apps are at the nexus of sage use, treatment outcomes and patient satisfaction. And it’s not science fiction.

At present, there are some 17,828 health care and fitness apps and 14,558 that can be deemed medical. While some are better than others, these numbers tell us one thing: this is not a fad or a trend. It is reality.

Will our socio-economic technology gap lead to a more pronounced adherence and compliance gap? It’s an important question. That’s why it’s crucial we remember there is no one-size-fits all solution. But that mustn’t mean we disregard the reality of the growth and pervasiveness of apps, mobile apps. Let’s face it, when it comes to mobile phones, any gap is rather narrow.

How do physicians feel about apps? A recent poll of 203 licensed U.S. physicians over six specialties (via a Sermo panel funded by the Mobile Health Library) found the benefits considered “valuable” or “extremely valuable” netted out as follows:

Apps for adherence and compliance are “safe use” apps. Apps that can be “prescribed” by physicians to their patients are the wave of the present. Adherence and compliance “app-ens” and patients, physicians, payers, pharmaceutical companies — and society benefit.

Peter J. Pitts, a former FDA Associate Commissioner, is President of the Center for Medicine in the Public Interest, a member of the Digital Health Council Board of Advisors, and Chief Regulatory Officer of Adherence Health Strategies.

Copyright 2013 Burrill & Company. For more life sciences news and information, visit www.burrillreport.com.