Addressing the adherence gap: A view from a Healthcare Psychologist

Poor medication use in patients with long-term health conditions is widely recognised as a global problem that urgently needs to be addressed, but there is still debate about the best ways of doing this.

During my 30 years’ experience I have investigated the influence of psychological processes on health, illness and health care delivery. The main focus of this has been on the ways in which patients’ beliefs about their illness and treatment affects self-regulation and self-management across a wide range of chronic health conditions.

From our research, we know behaviours that impact health decisions are determined by a range of psycho-social factors that vary across individuals. To achieve sustainable behaviour change requires an understanding of the key drivers behind certain behaviour and the adoption of appropriate techniques to help address these. The most dominant interventions, including many of pharma’s present-day solutions, have been based on two limited approaches; programmes have tended to be one-size-fits-all and reminder-based. The latter assumes the main drivers of non-adherence are people having insufficient information or simply forgetting to take their treatments. This is a huge over-simplification. Disease education and information alone won’t change patient behaviours.

Research into the determinants of treatment adherence, comprising reviews of literature and studies in this area, has identified three broad groups of behavioural factors– and each provides an umbrella for related sub-groups.

The COM-B model is one of many health psychology frameworks we apply to our work. Specifically, we look at how an individual’s Capability (e.g. knowledge; planning ability), Opportunity (HCP and social support; access to healthcare; finance), and Motivation (e.g. beliefs; mood; confidence) influence their adherence and self-management. These factors vary from patient to patient over time, as their experience of the illness and treatment or their social circumstances change.

Why would any support programme talk to a patient population in the same way when the barriers to adherence are based on personalised beliefs? Just as beliefs are individual, so should support programmes be individualised.

In patients with cardiovascular disease, and other chronic illnesses, there has been consistent evidence that not only do patients’ motivation and beliefs play a critical role in their self-management and recovery but also that the personalised interventions, which target these beliefs, can significantly improve many aspects of the recovery process.

Maintaining old approaches to medicines adherence will not solve the problem. Pharma has an opportunity to lead a collaborative effort to combat non-adherence. Companies must refine their thinking and approach the problem from a different perspective. Identifying and responding to the drivers of non-adherence is a complex exercise, but it begins and ends with the patient. Innovative approaches in cardiovascular care and personalised support strategies can ultimately make a difference to patients’ lives. Highly regarded industry events like ACC, provide a unique forum and opportunity to learn, collaborate and co-create with other healthcare stakeholders on potential solutions to many of the problems faced by CVD patients during treatment.

Fundamentally, adherence is about changing behaviours. As a result, progressive pharmaceutical companies seeking to solve the challenges faced by their customers are exploring the world of health psychology and behavioural economics to unlock the answers.

Change can be achieved. We are already starting to see this happen. Non-adherent behaviours cannot be properly addressed until we make a consistent effort to really understand patients and more importantly, we need to support their needs through scalable support offerings that utilise proven behaviour change techniques.

The rationale is clear: since drugs don’t work in patients who don’t take them, more must be done to model patient behaviour and support the real world challenges of CVD patients.