Presentation at eyeforpharma Multi Channel Marketing Conference, London, November 7th, 2013

1. Non-adherence is the norm- Legalize it!

2. “Increasing the effectiveness of adherence interventions may
have a far greater impact on the health of the population than
any other improvement in specific medical treatments”
Haynes RB. Interventions for helping patients to follow prescriptions for medications.
Cochrane Database of Systematic Reviews, 2001, Issue 1.

3. Poor adherence to treatment of chronic diseases is
a worldwide problem of striking magnitude
50%
... or lower depending on country
“Adherence to long term therapy”, WHO 2003

4. Self-regulation: Grasshopper vs. ant
Source: Self-regulation model, Leventhal et al. 1984

5. Beliefs drive behavior
Causes
Time
Control/
Cure
Identity
Consequences
Source: Illness perception model, J. Weinman et all 1995

6. Resisting medicines
Concerns
Overuse
Necessity
Harm

7. So does the Internet impact adherence?

8. We asked 200 patients in HealthUnlocked Lupus
community how they felt about adherence

9. About 60% admitted to having missed doses

10. ...mostly because said because they forgot

11. ...few admitted because of side effects

12. Going deeper though some deeper motives emerged
The drugs have lots of side effects
and sometimes i just don’t want to
take them...so I forget
I stopped, because I wanted to
know how I feel without med.
Just felt completely fed up and
couldn't be bothered.
Medication doesn't really make
me feel much better.
Scared by the thought that this is
my future and then find out that
most people think it is an
inevitable ...

13. Online engagement made patients feel better
informed and consequently more confident

14. ...which in turn had an effect on their adherence

15. Internet creates mostly POSITIVE change
Information
It makes you think about the
consequences of taking them
when you read about some of the
side effects that people suffer from.
It made me question drug regime
more.
Motivation
I was able to negotiate the
change with my NHS Endo after a
year on no meds. I now take in
split doses. I am doing well.
Skills
That people tend to explain their
experiences this has led me into trusting
the meds a little bit more.
Change
It encouraged me to wait for
the tablets to take effect.
It's the support you get and
the motivation and they
understand what you are going
through.
It helps me stick with my meds
despite the side effects reading what
other people have to put up with.
Gives me confidence to hear that
people have the same experiences
15

16. Information + Motivation + Skill= Behavioral Change
Info
+
Skill
+ Motivation =
Change

17. How can Multi Channel Marketing help?
Reinforcement
Product necessity and safety
Content
Change
Disease awareness
Patient information and education
Relapse prevention and
recuperation
Social Support
Commitment
Conversation
Self Monitoring
Tools
Behavioral
strategies
Behavioral contracting
Goal setting
Feedback
17

18. Payors “get it”: Non-adherence comes at a cost
Source: Medication Adherence Leads to Lower Healthcare Use and Costs Despite Increased Drug Spending, Health Affaires, 2011

19. Payors believe digital is part of the solution

20. Are we letting our patients down?
Products lie to us. Food says "low carb" or "sugar-free," but isn't good for us.
Nutritional information isn't always accurate, or has unrealistic serving sizes.
Companies and gadgets lie. We're told something makes diabetes "easy" or
"painless." Diabetes is never easy, and never painless.
My insulin pump is the best piece of technology I've ever had, but it
sometimes lies to me too. Sometimes it says it's delivering fine, but the
cannula is kinked so my sugars are suddenly in the 20s with no explanation? I
never know. How much of the insulin did I actually get?
Diaturgy blog

21. Are we expecting patients to behave according to
unrealistic standards we made up in labs?

22. Non-adherence is the norm- Legalize it!
Non-adherence is nothing new
but our definition of adherence is old
Need to transform adherence guidelines
into real world health outcomes
Patient empowerment is rising
and the internet is the elevator

23. Patients need to be supported not blamed
“Adherence to long term therapy”, WHO 2003

24. Self-Regulation-Experiment: social vs. hangover