Over the last few years there has been a paradigm shift in the belief that a patient adherence or support programme is an expensive ‘nice to have’, with drug manufacturers believing that it’s good enough to provide a one-size-fits-all range of interventions aimed at reminding the patient to take the treatment or giving them information about their condition.
Today, it is widely acknowledge that simple reminders and education are not the solution. Behavioural scientists have clarified that non-adherence to medication is a ‘normal’ human behaviour. It is the outcome of a range of psycho-social factors which differ from patient to patient, and change over time, based on their experience of the illness and as their social circumstances alter.
Adherence programmes are only effective if they utilise sophisticated clinical psychology techniques to support long-term behavioural change among those patients who are non-adherent. Evidence-based behavioural change interventions are used to screen patients to identify not only their risk of discontinuation, but also their beliefs and attitudes towards their treatment and condition. Adherence programmes with measurable real world data and improved health outcomes, need to focus on providing personalised communications that utilise evidence-based behavioural change models to address unhelpful beliefs and sustain long-term behavioural change.
Why is this necessary? Correctly adhering to a medication (or indeed any health-based lifestyle change) is an intentional behaviour. How often have you promised yourself you’ll start a new fitness plan, go on a diet or stop smoking only to procrastinate or quit after a few months? Patients with asymptomatic conditions, such as osteoporosis, Type 2 diabetes, hypertension and high cholesterol often don’t see an effect or outcome from their treatment. If they feel well and the medicine makes them feel worse or restricts their lifestyle, why should they continue to take it? The three most commonly cited reasons for primary non-adherence are general concerns about taking the medication (63 percent), a decision to try lifestyle modifications (63 percent), and fear of side effects (53 percent).
One clinician recently told me that during his consultation with an elderly patient, she had spent two minutes listening to his advice about the new treatment he prescribed and five minutes trying to negotiate with him as to why she shouldn’t take the prescribed treatment in the dosage and timing he had recommended. Like you and I, patients have their own views, beliefs and attitudes regarding their disease and treatment, and, because of this, require personalised support to adopt new behaviours and habits.
To make long-term changes in behaviour you need to understand and address how someone feels and thinks about adopting the new behaviour, along with ensuring that they can turn these thoughts and feelings into action.
