A Vote For Non-Adherence
Humans love to try new things, explore and fundamentally break the rules, we are simply not rational creatures, we are emotional ones, and are driven by our feelings and self-compromise.
For example, we know we SHOULD go to the gym and exercise at least 3 times a week, we know we SHOULD NOT eat takeaways and chocolate, but how many times have we compromised with ourselves that today I deserve to not do these things, instead, I will eat the cake and binge watch Netflix.
Patients are humans too and are no different in their approach to taking medications and the management of their overall health; and to anyone who states we ‘need to improve patient adherence’ – take a step back and notice that adherence is a by-product of engagement, when this is observed it becomes obvious that starting from adherence makes absolutely no sense!
I recently completed a 15,000ft skydive. I was absolutely cool and calm about the whole thing until I left the aircraft, at which point I realised what I had done and faced with Byron Bay and the Gold Coast as my potential death bed, my own mortality seemed inevitable.
Clearly, I did not die. But it got me thinking about patients when they leave their appointments. They have been given a diagnosis (probably) and a course of treatment (hopefully) but how much of the conversation with their HCP did they truly understand and absorb? Once patients have left the proverbial plane, they are on their own to make choices and manage their health and medication by themselves, and I’m almost willing to guarantee that irrespective of the severity of diagnosis, terminal or not, patients are unlikely to follow their instructions from the HCP faithfully.
So how do we improve adherence? Answer: we don’t. We improve understanding and engagement, and the only way to truly achieve this is to stop looking at the patient and start looking at the person.
This approach is not a new concept, super-nanny (yes I’m drawing parallels with that popular TV show) detailed to many parents how they can tame their almost feral children. Not through shouting and telling kids what to do, but taking a new approach based upon reasoning, understanding and reward. Wouldn’t it be something to do the same with patients too? Understand who they are and base systems and support around the person not the medication or the disease?
Don’t get me wrong patients are not feral children, but I can understand why a HCP would have compassion-fatigue with a patient who has type 2 diabetes that they have been warning for years is an inevitable diagnosis if they didn’t change their ways, and here the patient is: in front of the HCP receiving that inevitable diagnosis. But I believe if we take a different approach we can change this trajectory.
Pharma and healthcare institutions need to redefine their approaches. Not through literature and informative websites but through tools for empowerment and experiential support aimed at both patients and HCPs. We know more about a person through their interactions on their smartphone, their day to day activities, their social lives and their environments than ever before. Why not use this information (with their permission of course) to provide them with interventions to support in the moment? These tools will ultimately result in the optimal side effect of improved adherence, not through paternalistic messaging but through tools enabling an understanding and ease of medication management burden thus improving overall engagement for both HCPs and patients.
In today’s modern societies there really is no better way to provide these solutions than health technology. Whether it is for the patient, HCP or carer, health technology accessible through smartphones affords us greater opportunities than ever before to support HCPs diagnosing and managing their patients, and patients in understanding their diagnosis, managing their treatments, talking with their HCP and then being involved in the decisions around their care based on an informed relationship with their HCP.
So, I vote non-adherence because whilst patients continue to not do as they are told, for whichever reason they rationalise (side effects, forgot, I feel better, event coming up, travel, I just don’t want to!) they are demonstrating the most basic of human behaviours: rebellion. They are pushing HCPs, pharma, agencies and strategists to do better, focus on them on an individualistic level and stop seeing them as a population of patients. They are asking to be seen not as a diagnosis, but as we all wish to be seen: as a person, an n=1 and I believe health technology and patients themselves give us the greatest tools in medical history to change this landscape. We have the ability to engage our patients and support the HCPs treating them in new innovative ways that mould to their lives and understand who they are, revolutionising ‘adherence’ for patients long-term through true engagement and understanding. This can only be a good thing and I vote yes!