Understanding Attitudes and Adherence to Meds

August 20, 2015

Savio Fernandes, a confirmed diabetes patient, sits at his breakfast table wondering how many of the assortment of pills in his hand he should pop today- one, all or none. None he decides. There’s always a tomorrow for one and day-after for all. After all routines are dreary!

Adherence to medications is a problem of patient behavior and beliefs. It is estimated that about 50% prescription medicines are not taken as directed and about 15-20% may not be taken at all. What a waste, considering that the total global spending on medicines will reach almost $1.2 trillion in 2017(1). There are crusaders who believe that spending fraction of this money on improving adherence could have more significant outcomes. This is precisely where HCP communication in pharma plays a critical role — equipping doctors with the right tools, language, and patient insights to address non-adherence at the point of prescription itself. This may well be in line with the austerity measures during the economic slowdowns.

The issues affecting adherence are complex and multifactorial. The simplest way to deal with it is -education. But that’s about where the simplicity ends. Where will the education start and with what variables? As we focus relentlessly on a one size fits all patient education, the less countable it seems. Professor Rob Horne, an expert in psychology in health care at Brighton University, says: “One of the main reasons why people don’t take medicines is that they don’t want to.”

Why they don’t want is a matter of attitude. Attitudes have a momentous impact on adherence. There is a reason why patients behave the way they do. And it’s definitely not a single reason.
Attitude is a function of beliefs. Keshav believes there is nothing wrong with him. Asif believes prayers and not meds will treat his cardiac condition. Radha Devi feels guilty about her illness, she thinks it’s God’s way of punishing. Cynthia doesn’t know that skipping doses could lead to serious health complications. Aamir bhai doesn’t believe in meds.

Relationship marketing vehicles of several pharmaceutical marketers run adherence building programs. These are built around the ‘forgetting’ pivot and therefore mostly have reminder mechanics in place. Can a simple reminder to take meds work for Keshav, Radha, Cynthia or Aamir?
Segmenting patients into behavioral and attitude clusters and then customizing the programs might yield better outcomes. Dealing with someone with “I don’t believe it will work” is very different from “I just don’t remember”. An attitude centric adherence paradigm will help understand the patient’s beliefs and motivation levels at the beginning of the journey.

In a unique attitudes study on diabetes and non-adherence, Brandcare has interviewed physicians, diabetologists and people with diabetes in India. This has helped arrive at clusters of patient types basis their attitudes to adherence. The report, titled Non Adherence in Diabetes- an Attitude Study, will be of interest to pharmaceutical marketers who wish to orchestrate non-adherence tackling patient programs. It makes large sense to them since acquiring new patients costs pharmaceutical companies an average of 62% more than retaining the ones they already serve(2). It will also benefit medical bodies and associations who are working in the field of improving outcomes in chronic diseases.

-Rashmi Thosar
CEO, Brandcare

FAQ

What causes non-adherence to medication in India?

Non-adherence is rarely about forgetting. It stems from deeply held beliefs some patients don’t believe they’re unwell; others trust faith over medicine; many feel guilt or shame around their diagnosis. The causes are as varied as the patients themselves, which is why blanket adherence programs consistently fail to deliver.

How can pharma brands improve patient adherence?

By moving from demographic segmentation to attitudinal segmentation. Grouping patients by beliefs and motivation reveals what each group actually needs; it could be education, reassurance, reminders, or motivation. A patient in denial needs conviction-building; a forgetful one needs nudges. Solving the right problem for the right patient is where adherence programs win.

What role does HCP communication play in medication adherence?

Enormous. The physician’s voice often carries more weight than any brand communication. How a doctor frames urgency, consequence, and empathy can meaningfully shift patient attitude. But generic instruction rarely moves the needle. HCPs equipped with attitudinal insights about their patients are far better positioned to have conversations that actually change behaviour.

Why don’t reminder-based adherence programs always work?

Reminders solve a logistics problem, but not a belief problem. A patient who thinks “I’ll be fine without it” won’t be moved by an SMS nudge. Attitude barriers need attitude solutions. Until programs are designed around why patients disengage, not just when, they will continue to underperform.

Is it more cost-effective for pharma companies to focus on patient retention than acquisition?

By a significant margin. Retaining existing patients costs far less than acquiring new ones, making adherence programs a commercial imperative rather than just a clinical choice. Every patient who drops off the treatment journey is a measurable loss. Simply put, understanding exactly why they disengage and acting on that information is smart business.

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Understanding Attitudes and Adherence to Meds

August 20, 2015

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