Why We Need Deep Medication Adherence Information

It is important to remember that one of the key reasons for gathering medication adherence data is to facilitate a conversation with a health provider regarding the complex issues of side effects, burden and cost, as well as other behavioural, psychological and financial reasons why a patient may be struggling with medication compliance.  These reasons need to be captured, respected and discussed, in order for behavioural change to be enabled.

 

In the emerging market for digital health, there are many organisations developing solutions for reporting on and improving medication adherence.  This is a noble goal, particularly when you consider that at home medication compliance for chronic disease patients is estimated to be around 40-50%.  This statistic should be deeply concerning to all of us.

In order to be able to improve medication adherence, I think it’s clear that we need better data to help us understand current patient behaviours.  Only then can we adequately measure a variety of techniques for driving behavioural change.  The opportunity to apply a range of approaches using gamification and inspired by behavioural economics is exciting, and full of promise.

However, based on my recent experience, I’m not convinced that many of the organisations currently working on digital solutions for medication adherence have a real grasp of what adherence means.  In almost every case, the solutions that I have seen model medication adherence simply as a binary outcome.  I took a medication.  I didn’t take a medication.

The problem with this view of medication adherence is that it doesn’t give me anything to work with from a behavioural change perspective.  In fact, it risks being paternalistic, as we can easily fall in to assuming the reasons for non-adherence.  I’ve seen the following assumptions made regarding non-adherence:

  • Patients don’t take their medications because they have low health literacy, and don’t understand / aren’t capable of understanding why they need to take them
  • Patients from lower socio-economic backgrounds don’t care about their health and so don’t take their medications
  • Many patients are just forgetful, and don’t remember to take their medications

 

Whilst these reasons for non-adherence can be true in some situations, the reality behind patients not complying with medication regimes is far broader and more complex than what is suggested above.

It is important to remember that one of the key reasons for gathering medication adherence data is to facilitate a conversation with a health provider regarding the complex issues of side effects, burden and cost, as well as other behavioural, psychological and financial reasons why a patient may be struggling with medication compliance.  These reasons need to be captured, respected and discussed, in order for behavioural change to be enabled.

At this point, I’d like to show you the medication adherence model captured by PatientsLikeMe.  These guys have done an amazing job of capturing the complexity that sits behind the reasons for poor medication compliance.  Take a look at the following diagram:

 

picture1

 

As you can see, patients are asked to report on the following measures with regard to medication adherence:

  • What did I take the medication for?
  • What did I perceive the effectiveness of the medication to be?
  • What side effects did I perceive / experience from taking the medication?
  • What dosage did I take?
  • Why did I stop taking the medication?
  • How long have I been taking the medication?
  • When did I stop taking the medication?
  • What is my adherence to the medication generally like?
  • What burden do I experience in taking the medication?
  • What is the cost of the medication for me?
  • Which medication did I take before moving to this one?
  • Which medication did I move to after taking this one?

 

This set of data is what I am starting to call “deep medication adherence information“.  It helps in forming the complex picture that surrounds medication adherence, and can be used to facilitate a powerful conversation with a health provider.  Only by facilitating this conversation can we provide the necessary support for digital health solutions to move the needle on the challenge of medication adherence.

 

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  1. Why We Need Deep Medication Adherence Informati... - February 20, 2017

    […] n the emerging market for digital health, there are many organisations developing solutions for reporting on and improving medication adherence. This is a noble goal, particularly when you consider that at home medication compliance for chronic disease patients is estimated to be around 40-50%. This statistic should be deeply concerning to all of us.In order to be able to improve medication adherence, I think it’s clear that we need better data to help us understand current patient behaviours. Only then can we adequately measure a variety of techniques for driving behavioural change. The opportunity to apply a range of approaches using gamification and inspired by behavioural economics is exciting, and full of promise.However, based on my recent experience, I’m not convinced that many of the organisations currently working on digital solutions for medication adherence have a real grasp of what adherence means. In almost every case, the solutions that I have seen model medication adherence simply as a binary outcome. I took a medication. I didn’t take a medication.The problem with this view of medication adherence is that it doesn’t give me anything to work with from a behavioural change perspective. In fact, it risks being paternalistic, as we can easily fall in to assuming the reasons for non-adherence. I’ve seen the following assumptions made regarding non-adherence:Patients don’t take their medications because they have low health literacy, and don’t understand / aren’t capable of understanding why they need to take themPatients from lower socio-economic backgrounds don’t care about their health and so don’t take their medicationsMany patients are just forgetful, and don’t remember to take their medications  […]

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