There is no Pill for Non-Adherence Part II
Barriers to adherence are usually organizational, not patient related.

We at MEMOTEXT believe that the healthcare system is at a cross-roads in the transition from theory to implementation, and by implementation I mean commercialization. There is a body of work out there that is disparate and passionate but far from organized, disciplined or properly resourced. Below I have listed the four critical elements to effecting real change to come up with real solutions to the problem of non-adherence:

1) Patients at the Core of the Solution: Solutions must be patient-centered with tailored solutions for particular problems. Patients must be screened in order to apply behavior-appropriate models. What does this particular patient require to modify their behavior? Mentoring, tele-mentoring, location specific reminders. We know why people do not comply with treatment plans. Identify the reasons and apply the solutions.

2) Structured Approaches: Multifaceted methodological thinking is required to apply analysis and iterative (sometimes multiple) solutions at various stages of the patient journey. Follow the graph and apply the appropriate solution at the appropriate time.

3) Time: The business case for improving non-adherence is simple but it takes time to make itself obvious. When non-adherence is measured in quarterly increments the benefits are not attainable. A patient lifecycle approach to metrics is required to see perceptible, measurable results.

4) Change Management: Adherence programs are treated like billboard campaigns. These are not simple initiatives. Cross organizational impact analysis is required. When you see barriers to adherence, they always refer to the patient. Oddly enough the barriers are not patient initiated, they are organizational barriers. Patients are simply stakeholders in the process.

We understand the severity of the problem and that that we need solutions. Another analysis of the costs and benefits of improving medication adherence would be redundant and a waste of money at this point. It’s time to bring all of the agendas together, because the truth is that, these agendas can co-exist and together provide the motivation necessary for organizational mind-shifting.

There is no pill for non-adherence. Combating the barriers to adherence requires a disciplined, rigorous, traceable approach encompassing the scope of situation, environment, demographics, medical condition, stakeholder specific requirements and iterative disciplined solution design to modify behavior, achieve outcomes and ensure not simply economic viability but material profitability to ensure adherence remains a strategic priority.

There is no Pill for Non-Adherence Part I
by: Amos Adler, President MEMOTEXT

Though dangerously wide in scope and scale, non-adherence issues do not yet appear to be top priority for health organizations and stakeholders.

Much to the detriment of patients and overwhelmed health care systems, adherence continues to be viewed as a ‘medical issue’. To date, even the best efforts of care givers, administrators, and pharmaceutical companies have proven ineffective at addressing the adherence needs of the patients and the healthcare system. Medical professionals operate in vacuous silos unable to effect lasting change, while healthcare stakeholders and pharmaceutical companies chug along unable to see the forest for the trees. There are exceptions of course, but they are few and far between. More and more is being written about the holy grail of non-adherence and the lack of solutions for this multi-billion dollar problem. There are incentive programs, education, reminders, surveys. There are failed projects, vendors pushing their wares and managers protecting their interests. As a health care communications and information services organization, we come across this every day.

With a background in systems development it is particularly amusing that anyone would think solutions are to be found in bullet lists and quick fixes. Information systems design and adherence/compliance, are age-old problems with no silver bullet. Unfortunately, not enough resources have been devoted to the pursuit of adherence as a discipline. What will it finally take to drive adherence to the forefront? Perhaps a shift in perspective. A shift from a solutions oriented approach to an understanding and acceptance of non -adherence as an academic discipline. It is not a science, it is not an art. It is an alchemyof disciplines including organizational management, systems oriented thinking, medical science, behavioral science, communications, demographics, psychographics and economics.