Are We Ignoring Important Adherence Information?

By | December 4, 2013

What if all barriers to adherence are not created equal? The immensity of available adherence information may obscure core ‘veto’ barriers that negate common types of intervention. Exploring this idea opens up major new adherence insight opportunities.

Hidden Gems of Adherence Information

The immensity of available adherence information may obscure core ‘veto’ barriers that negate common types of intervention.It’s a common enough phrase, but how about if it applies to medication adherence? After years of research, have we gotten to the point where we can’t see the forest for the trees?

Here’s a simple example. If you type “medication adherence” into Google, you get around 4.25 million hits. As a crude estimate, it might take about 80 years to browse through this number of hits! That’s plenty enough space to ‘hide’ a few critical pieces of overlooked adherence information.

We still struggle to find effective interventions to improve adherence. So perhaps it’s time to look anew at what we know; to see if some approaches are much more important than was originally thought?

‘Veto’ Barriers and Where to Look for Them

Do ‘veto’ barriers exist? Some key pieces of adherence information suggest they might. For example, take a look at improvements in adherence rates seen with the following common interventions.

Patient education (with telephone and mail support): 6% in hypertension patients; 4%-6% in myocardial infarction patients (see here for both).

Cost mitigation/reduced patient copays: 4%-6% in post-myocardial infarction patients (see here), 2%-5% in diabetes, hypertension, hyperlipidemia, or congestive heart failure patients (see here).

As patient understanding and medication costs both feature regularly in reasons for non-adherence, surely we’d expect better than single digit improvements? Maybe not if there are higher, ‘veto’ barriers in play.

The concept of a ‘veto’ barrier is simple. It’s a barrier that is so important and so influential that it negates other adherence interventions. To effectively inhibit other interventions, it has to be present in broad patient populations. Which suggests such ‘veto’ barriers might be driven by the human mindset or psychology?

That seems like a good place to start.

A Fresh Look at Patient-focused Adherence Information

Adherence information suggests there may be higher, ‘veto’ barriers that negate many different types of interventions.So what can patient-centric adherence information tell us?

There’s plenty of evidence that patients often intentionally choose not to adhere to their medication regimens. It’s a conscious decision they make, for a variety of different reasons. For such patients, lack of motivation to adhere is a unifying factor.

I also guess we’d all agree that non-adherence is a behavioral issue. More specifically, it’s a behavioral change issue – involving the change from non-adherence to adherence. And health behavior changes are very difficult to achieve, which readily places them in a ‘veto’ barrier role.

Patient Motivation a Possible ‘Veto’ Barrier

So lack of patient motivation to change their adherence behavior may well be one ‘veto’ barrier. In which case, interventions to increase a patient’s motivation take on a critically important role. Indeed, the value of other types of interventions will be limited unless this – or any other – ‘veto’ barrier is not addressed first.

What about other potential ‘veto’ barriers?  Does different adherence information lead us to other ‘vetoes’? Any thoughts?