Public Service: Improving Adherence

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Robin Robinson

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By Robin Robinson

For the next three years, the National Consumer League and its 100 partners will focus on improving adherence for chronic diseases. With almost 75% of patients in the United States not taking medicine as prescribed by their doctors, the public awareness campaign, Script Your Future, has a big job ahead. The campaign, led by the National Consumers League (NCL) and more than 100 partners, aims to educate patients, especially those with chronic diseases, on the need to take medicines correctly. For the next three years, the campaign, which kicked off in May, will inform patients about the risks of not properly taking their medications by using free text message reminders, sample questions, medication lists, and charts that help track medicines and fact sheets on common chronic conditions. Adherence is an Uphill Battle It’s definitely a challenging road ahead, but if the campaign can encourage the number of people who are prescribed medicine and never get the prescription filled, the outcome will be a win-win for everyone. Patients will be healthier, healthcare costs will decline, and the pharmaceutical companies will benefit not only in more drugs being used, but also from being seen as part of the solution for improved health in the United States. According to the Script Your Future campaign, the three-fourths of U.S. patients who don’t adhere to their medication therapies create costs in the healthcare system of $290 billion per year. The campaign focuses on chronic health problems, such as diabetes, COPD, asthma, high blood pressure, and high cholesterol, that can be effectively managed through drug therapy. The NCL’s many partners come from every sector of the healthcare system, including healthcare professionals, patient communities, family caregivers, pharmacies, health insurance plans, pharmaceutical companies, associations, as well as government agencies and researchers. Sponsors from the industry include Lilly, Merck, GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Pfizer, and Sanofi. As part of its outreach to the healthcare community, NCL is asking stakeholders to identify and submit existing adherence tools for patients and healthcare practitioners so that the group can gather credible resources and provide them to anyone who can use them. Tools may be focused on medication adherence in general or more specifically on the chronic diseases themselves. Resources may include educational programs; books or articles from credible, authoritative sources; adherence aids and devices for patients and for practitioners to use with patients; and CME courses and other educational resources that can assist patients, family caregivers, and healthcare practitioners in improving medication adherence. The NCL will review the tools for certain criteria before posting them on its website. According to Rebecca Burkholder, VP of health policy at NCL and Script Your Future campaign leader, the campaign is focused on these particular chronic conditions because of their prevalence in the United States, as well as the fact that they can be controlled with established medicines. “By focusing only on these chronic conditions, we can reach millions of people and really make an impact if we can encourage patients to understand their conditions and the consequences of not taking the medications that can help them manage their disease,” Ms. Burkholder says. The primary goal of the campaign is to increase awareness, and the NCL has taken steps to ensure campaign results can be measured. “We hope to eventually see an increase in consumer awareness of the importance of adherence that we can measure through an evaluation component and compare results with the baseline surveys we have conducted not only in our target markets but nationally,” Ms. Burkholder says. “We will repeat the survey again to determine the impact the campaign has had, particularly around consumer awareness, patient behavior, and communication with healthcare practitioners.” The NCL is also currently working with its partners to set up tracking capabilities for refills and pickups at the pharmacy counter to capture the impact being made there, as well as monitoring how many people visit the website and download the tools offered. Learning from Others Several years ago, there was a collaborative effort in the United Kingdom that had a broader mission, called Ask About Medicines. Established in 2003, the campaign organization included 1,500 partners from the Department of Health, a wide range of patients, NHS representatives, academic institutions, and professional organizations as well as pharmaceutical companies. The Ask About Medicines mission was to achieve lasting change by working with partners to encourage better communications between people and their health professionals and to change expectations so that asking questions about medicines became a common practice among patients. Originally a five-year strategy, the campaign ran an extra year until 2009. Campaign board members report that the effort was a success. The initial website still exists and includes the resources built during the campaign that are still available to the public. Di Stafford, director of The Patient Practice in London, who served on the advisory board for Ask About Medicines, says one of the major challenges inherent with any public awareness campaign is sustaining momentum over time. “As a campaign progresses, it gets increasingly difficult to say something new to maintain interest,” she says. “Creating tools and resources that leave a legacy long after the campaign is finished can be helpful. As an industry, we need to learn to be very clever and creative in our approaches.” One of the advantages the NCL campaign has in today’s environment is social media, Ms. Stafford says. The use of social media gives the NCL campaign a leg up on reaching the right audience in real time with relevant information. The campaign has a presence on Facebook, YouTube, and Twitter, and according to Ms. Burkholder, many of the visitors to the campaign’s website were directed there via Facebook. The campaign also uses texting capabilities to remind patients to take their medications or to send other health-related information. “Social media is very important for this campaign and we recognize it is driving much of our traffic,” she says. Along with social media, the campaign will look to its many partners to help get the message out. “Some of the strengths of this campaign are the number of committed partners involved and the many different channels available to reach the patient,” she says. One of the campaign’s 100 partners is Sanofi, which joined the effort because the company is focused on reducing the financial burden on the healthcare system caused by nonadherence. “As an active member and sponsor of this important nationwide collaborative effort, we know that Script Your Future will have a significant impact on the lives of patients and caregivers,” says Joel Beetsch, senior director, U.S. advocacy, Sanofi. “The partners of the program have joined forces to collect and share medication adherence tools that can be used by patients and their healthcare providers.” Benefits for All While patients are the first and foremost beneficiaries of a positive outcome of the campaign, partners also benefit by being part of the solution, Mr. Beetsch says. “Patients will benefit from the various tools provided by the program’s participants that describe the challenges with taking medication and give strong health-related reasons why adherence promotes well-being and reductions in avoidable costs,” he says. “Campaign partners, on the other hand, benefit by actively engaging in the development of medication adherence materials and by helping to shape the direction and impact of the program.” Solving a perpetual problem like nonadherence can only happen through the leadership of advocacy groups, such as NCL and the efforts of all stakeholders, says Ted Lithgow, chief science officer, MWV Healthcare, another partner in the campaign. “Advocacy groups such as NCL help to involve all stakeholders equally to ensure the issue is tackled through multiple channels with the broadest possible meaningful and positive impact on public health,” he says. Mr. Lithgow is also enthusiastic about the number of pharmaceutical companies that are taking a role in the campaign, saying they hold the real key to the solution of nonadherence. “They have enormous and often very rich databases of both clinical data and patient behaviors that influence medication-taking behavior,” he says. “That knowledge can help us find ways to create easy-to-use tools, such as adherence packaging and patient education, to make it easier for patients to comply with their healthcare provider’s recommended treatment plan and, ultimately, to have a better health outcome.” According to Ms. Burkholder, this type of collaboration is what will make the campaign successful. “This is a groundbreaking campaign and we need everybody who touches a patient in any way at the table,” she says. “There has to be a coordinated effort and everyone has to relay the same message.” In the end, it’s a win-win situation for everybody, Ms. Burkholder says. Consumers will become empowered, healthcare outcomes can be improved, and huge healthcare cost savings can occur. Editor’s note: To learn how your organization can become involved and support the campaign, contact Larry Bostian at larryb@nclnet.org or 202-835-3323, ext. 826. FAst fact Three out of four Americans admit they do not always take their medications as directed. Source: National Consumers League “The Script Your Future campaign will have a significant impact on the lives of patients and family caregivers.” Joel Beetsch / Sanofi “Solving the issue of nonadherence can only happen through the efforts of advocacy groups and all ­ stakeholders.” Ted Lithgow / MWV Healthcare Tips to Develop a Successful Public ­Awareness Health Campaign Di Stafford, director of The Patient Practice, served on the advisory board of the U.K. Ask About Medicines ­campaign from 2003 to 2009. She provides four best practices from that experience. 1. Have clear objectives for the campaign and ensure all activities are closely aligned to achieve these. 2. Keep the messages fresh, relevant, and motivating. People need a compelling reason to return to a ­website, Facebook page, or Twitter feed. 3. Identify the campaign’s outcomes. What elements will continue after the initial campaign has ended? 4. Adherence is a difficult subject to get people excited about, so it’s important to find a way to make it ­relevant and interesting to patients. Source: Di Stafford. For more information, visit thepatientpractice.com. The Script Your Future Campaign: ­Sponsor Benefits » Enhance patient safety and improve the healthcare system at large » Ensure a healthier and more productive ­workforce » Build relationships within the healthcare ­sector and develop alliances » Strengthen company reputation for good ­corporate citizenship through low-risk, high-gain collaboration in a public-private partnership led by a respected consumer ­advocacy organization » Access to campaign messages and themes Source: National Consumers League. For more information, visit nclnet.org EXperts Joel Beetsch. Senior Director, U.S. ­Advocacy, Sanofi, a global ­pharmaceutical company that discovers, develops, and distributes therapeutic ­solutions to help improve the lives of patients. For more information, visit sanofi.com. Rebecca Burkholder. VP, Health Policy, National Consumer League, whose mission is to protect and ­promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit nclnet.org. Ted Lithgow. Chief Science Officer, MWV Healthcare, a global packaging and packaging solutions company. For more information, visit meadwestvaco.com. Di Stafford. Director, The Patient Practice, a ­consultancy that helps commercial, public, and ­voluntary organizations to understand and ­interact with patients better for mutual benefit. For more information, visit thepatientpractice.com.

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