Healthcare: How to cut drug waste

Half the NHS drugs budget is wasted, as patients fail to take prescribed medicines. The challenge for health PROs is to spell out why this won't do, says Rob Gray

Almost half of the medicines prescribed for patients with long-term medical conditions are not taken properly. They either cease to be taken at all or their effectiveness is compromised by consumption at incorrect intervals or dosages. This shocking estimated figure is fairly consistent across the developed world, and higher still in developing countries, according to the World Health Authority's research on adherence to long-term therapies.

This so-called non-compliance is an issue of great concern to the governments of European Union nations. Colossal amounts of healthcare spending go to waste because consumers do not complete their courses of treatment - a state of affairs that can lead to their conditions worsening and requiring hospital treatment, adding further to the healthcare bill.

Patient compliance is also a major concern for pharmaceutical companies.

It stands to reason that, by persuading more patients to persist with their prescribed therapies, pharma firms will be better able to prove their effectiveness, sell more drugs and boost revenues. The logic is impeccable, but the reality falls far short of the ideal. Few pharmaceutical companies have yet managed to develop patient communication programmes that genuinely push compliance levels upwards.

Making compliance a partnership

An influential report, From Compliance to Concordance, developed following an enquiry into patients taking medicines, brought the new term 'concordance' to the fore as far back as 1995. Concordance means that the process of prescribing and taking medicine should be based on partnership.

Research from A Question of Choice: Compliance in Medicine Taking, published by the Medicines Partnership in October 2003, shows that patients are more likely to take their medicines as prescribed when they understand and accept the diagnosis, agree with the treatment proposed and have their concerns about medicines addressed.

To achieve greater concordance the Department of Health launched the Task Force on Medicines Partnership in January 2002. This was initially intended as a two-year initiative, but its life has been extended by 18 months.

'We are trying to change the culture of how health professionals interact with patients, which cannot be achieved in two years,' says Medicines Partnership project manager Geraldine Mynors. Medicines Partnership works with both health professionals and the pharmaceutical companies to bring about best practice in concordance. It can point to some moves in the right direction, such as Roche's programme for Xenical (see case study overleaf). Mynors says she sees signs of the PR industry becoming a little bolder at constructing helpful programmes.

Avenue HKM medical education director Lucy Kirkpatrick agrees. 'We need to shift the focus to communicate more about the drugs themselves,' she says. 'We must explain to patients why they need to stay on these drugs, and what will happen to them if they don't.'

Elsewhere, Kinetic Consumer Communications MD Karen Moyse thinks it strange that the industry spends so much on getting new customers, but so little on existing customers. 'As practitioners, we need to learn from loyalty schemes in consumer marketing,' she says. 'What we do has got to be more interesting and deal with what the patient wants, rather than maintain a paternalistic approach.'

Biogen is one pharma company that is doing just that through its Avonex therapy support programme for patients with multiple sclerosis. Patients participating in the support programme receive periodic phone calls from nurses so they can voice any concerns they might have about their MS or therapy, and can receive additional support. The telephone service is linked to a team of homecare nurses employed by Clinovia.

Baird's Communications Management Consultants co-founder Mark Chataway expects to see more such initiatives and feels the old pharma industry model no longer works. He argues that the industry should look for inspiration to the long-term customer management programmes developed by banks and airlines.

'The stuff you make real money out of is the medicines people take for a long time or for life,' he says. 'It's crazy that the big companies spend a fortune attracting customers and then lose half of them in six months.'

It seems inevitable that patient-support programmes will emerge that use communications channels such as telephone support lines, text messaging and websites to help shore up concordance. These will work best if they harness the involvement of patient groups.

Heart patients could benefit

Both in-house PR teams at pharma companies and agency healthcare specialists undoubtedly have a role to play in shaping strategy and developing content.

For example, Moyse cites heart disease as a condition suitable for patient support websites that contain advice on relevant lifestyle issues, such as diet and stress management.

Smart money is riding on a boom in 'decision aides' - whether booklets, videos or material in other formats - that explain medical conditions and their treatment options. These could have a significant role to play in achieving concordance by patients in the know. 'Decision aides are fairly widely used in the US, but not much here,' says Mynors. 'Working through a decision aide helps patients go into a consultation with a healthcare professional on more of an equal footing.'

Consumation principal consultant David Dickinson, a former editor of Health Which?, says that even the smallest changes in patient communications wording can have a large impact, not only on understanding but also on how an individual feels about a course of treatment.

Dickinson is also co-chair of Promoting Excellence in Consumer Medicines Information (PECMI). PECMI worked with Medicines Partnership and Doctor Patient Partnership to launch Ask About Medicines Week (AAMW) on 12 October 2003,which aimed to educate patients and the general public, encouraging them to access information about their medicines from a range of sources, including the pharmaceutical industry. Initiatives such as AAMW are pushing concordance up the agenda. Bodies such as the National Institute for Clinical Excellence (NICE) are looking at drawing up concordance guidelines and, in the future, Primary Care Trusts (PCTs) may be evaluated for their achievements in this field.

Opportunities for pharma firms

This presents opportunities for pharmaceutical companies to help PCTs reach their targets by offering services rather than product promotion.

Pfizer, for one, has been active in this respect, providing PCTs with health professionals to conduct medication reviews.

Pharmacists will be an equally important group. 'Some companies are slightly sniffy about pharmacist programmes, but pharmacists are very important in delivering concordance and compliance,' says Moyse.

Next month, eyeforpharma is staging its Patient Compliance for Pharmaceutical Companies conference in London. Clearly, this is an issue drugs companies need to address. That almost half of all medicines prescribed for long-term complaints are not taken verges on the scandalous. More needs to be done on this matter - for everyone's benefit.

CASE STUDY - XENICAL MAP

Roche Products developed the MAP (motivation, advice and proactive) support line as an initiative to help patients get more benefit from its prescription-only weight-loss treat-ment, Xenical.

Over five years, MAP has supported more than 45,000 patients, helping them to develop an understanding about weight management through lifestyle and treatment advice.

MAP is a complete patient support system that involves a two-way call centre run, on behalf of Roche, by independent company International SOS.

Independent healthcare professionals staff the phone lines, and patients can receive written information to guide them through the lifestyle changes required for successful weight loss and control. MAP also provides patients with support and advice on healthy eating and increasing physical activity, complementing advice given by patients' own healthcare professionals.

The healthcare professionals at MAP help patients set realistic, achievable treatment goals they are comfortable with and will also offer them encouragement.

Furthermore, MAP takes calls from healthcare professionals, who can discuss the advice given to patients, and obtain examples of the literature patients receive.

Patients are told about MAP by either their GP or pharmacy, and are given a free-phone number to ring to register for the programme. Patients can opt for follow-up calls at days 15, 30, 90 and 180 of their programme, and can call in to MAP at a time convenient to them.

Patients are also sent monthly newsletters designed to consolidate the information discussed over the phone. Topics include smart shopping, reading food labels, hidden fats, managing weight plateaux, physical activity and eating out. Patients are also sent a food diary, a fat and calorie counter and a pedometer at various stages to monitor their progress and help with motivation.

The optimum blend of inbound and outbound calls and regular mailings has evolved over the course of the programme. In response to the compliance results achieved with different combinations of calls and literature tested in the past, MAP has developed into an award-winning, industry-leading patient support programme championed as an example of best practice by Medicines Partnership.

'MAP gives extra motivation that a GP's surgery would not necessarily have the time to do,' explains Roche PR manager Susie Hackett.

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