The Adherence Problem: Are Patients Just Forgetful, or Are They Rebellious?

This is the adherence season for pharma industry conferences. This Monday and Tuesday was the 12th Annual Patient Adherence and Support Summit produced by CBI. This Thursday and Friday is the Patient Summit USA 2013 produced by eyeforpharma.

I've been following the Twitter stream from the latter. Two of them stood out:

@susanmees (Susan Mees; Director, Community Relations at Wegohealth) reported: "Of every 100 prescriptions written, only 50-70 are filled, 48-66 picked up, 25-30 taken according to directions."

Meanwhile, @StaffordPharmRX posted a link to an eyeforpharma article: "A Post-It Note Solution to Patient Adherence: Achieving Success with Simplicity" (here).

In that article, Anthony Londino, president of Med-Con Technologies, a company providing medication adherence tools, said

"People don’t take their medication because they don’t remember, and they don’t have a method to confirm that they have taken it."

That struck me as being at odds with the information that Susan posted. That data suggests 30% to 50% of the time people simply refuse to fill their prescriptions and pick them up (I doubt they can be so forgetful as to forget to go to the pharmacy after the doc writes a script). Only 20% to 25% of the time are people "forgetting" to take their medications "according to directions."



It seems to me that most non-adherence is due to patients "rebelling" against their medications for one reason or another -- just refusing to follow their doctor's advice and fill the script. It's not about forgetting.

Yet, whenever a pharma company decides to do something to improve adherence, the focus is almost ALWAYS on "reminders." The latest fad are reminder smartphone apps such as Care4Today, a "secure mobile app and website" that was developed and recently released by Janssen Healthcare Innovation.

Are such apps designed for the patient or for the pharma company? Jannsen gets a lot of benefit from the personal data collected by the app, whereas patients would get hardly any benefit from the app that they couldn't get from simply using their smartphone calendar. For more on that, see "Adherence: Do We Really Need an App for That?"

Anthony Londino sent me the following comment via LinkedIn:

"Forgetting is only a single piece to solving the puzzle of patient non-adherence. It has been well documented there are multiple "barriers" to this problem: not filling the prescription, cost of drug, patients perceive they don't need the medicine any longer as they are feeling better, and several others. Forgetting to take medication, and not having a way to confirm it has been taken, has been documented to being in the top five barriers to adherence.

"I'm sure there are people who rebel against taking medication. But I also believe that if a person is going to choose to be non-compliant in taking their meds, it will be very difficult to invoke a behavior change in that person. Conversely, if a patient wants to be compliant, then providing tools to help them do so, will help improve adherence. Additionally, such programs like patient intervention, and above all patient education about the importance of both taking and staying on medication are very important as well. Hopefully, the result will be a better relationship with their physician, and the ability to be better to self manage their medication regimen."