Slide 1: Educational purposes disclaimer
This presentation is offered for educational purposes only, intended to serve as continuing medical education for health care professionals. The content of the presentation represents the views and opinions of the original creators of such content and does not necessarily represent the views or opin
Slide 2: The Global Challenge of Medication Adherence
INTRODUCTION – THE UNIVERSAL CHALLENGE OF MEDICATION ADHERENCE The Global Challenge of Medication Adherence Prof. John Weinman School of Cancer & Pharmaceutical Sciences King’s College, London, UK GLO2208851 | Oct-21 | 2
Slide 3: Disclosures
Disclosures I have presented talks for I received a PhD research Abbvie, Abbott, Bayer, grant from Merck, and Chiesi, Boehringer serve on the Behavioral Ingelheim, Roche Science Advisory Board and Merck. for Sanofi GLO2208851 | Oct-21 | 3
Slide 4: Outline
Outline The multiple What causes Implications for challenges of non-adherence: intervention medication A behavioral science development, adherence perspective training & clinical care GLO2208851 | Oct-21 | 4
Slide 5: Behavioral Science and Treatment Adherence
Behavioral Science and Treatment Adherence Behavioral science is used to Investigate the nature, extent, causes and consequences of non-adherence Develop methods for assessing the nature and causes of non-adherence Develop/adapt theoretical frameworks for understanding/explaining adherence Develop t
Slide 6: A global problem?
A global problem? GLO2208851 | Oct-21 | 6
Slide 7: ALIGN Study (Michetti et al, 2017)
ALIGN STUDY (Michetti et al, 2017) WESTERN EUROPE AND EASTERN EUROPE & LATIN AMERICA (%) ASIA-PACIFIC (%) CANADA (%) MIDDLE EAST (%) Canada 7 France 6,9 Czech Republic 5,1 Mexico 4,1 Spain 6,9 South Korea 4,2 Romania 4,1 patient population Italy 5,5 Germany 4,1 Slovakia Sample Sweden 3,1 3,5 % of to
Slide 8: The extent of non-adherence
The extent of non-adherence WHO REPORT ON ADHERENCE (2003) 1 OECD HEALTH WORKING PAPER (2018)2 • Estimated that 30 - 50% medicines prescribed for • Poor adherence contributes to 200,000 premature long term illnesses are not taken as directed deaths in Europe per year • Estimated annual cost : EUR 12
Slide 9: Economic impact of medication nonadherence by disease groups: a systematic review
Economic impact of medication nonadherence by disease groups: a systematic review 79 individual studies assessing the cost of medication non-adherence across 14 disease groups were included Wide-scoping cost variations were reported, with lower levels of adherence associated with higher total costs
Slide 10: WHY ?
WHY ? Drivers of patient behavior 1 Health care professional behavior 2 Healthcare system factors 3 GLO2208851 | Oct-21 | 10
Slide 11: Early explanations
Early explanations Early theories based on idea that non-adherence was result of poor communication & subsequent effects on patient understanding and memory. Early interventions mainly based on information provision, and/or reminders and these are still used 1 Do these work? – only in those who are
Slide 12: More recent explanations
More recent explanations RECOGNITION OF 3 PHASES OF ADHERENCE 1 Uptake Implementation Persistence A very large number of potentially modifiable factors cause non-adherence 2. HOW TO CLASSIFY THESE? Capability/ Modifiable Intentional Perceptions Opportunity/ v v v Motivation Unmodifiable Unintentiona
Slide 13: COM-B Factors related to non-adherence
COM-B Factors related to non-adherence ADHERENCE CAPABILITY OPPORTUNITY MOTIVATION • Understanding • Relationship with HCP • Illness & Treatment • Forgetting • Social support Beliefs • Planning/organising • Finance • Treatment Fears • Dexterity • Access to healthcare • Emotional Wellbeing (depressio
Slide 14: Patient Factors - Summary
Patient Factors - Summary Very many factors have been found to influence adherence 1 Large variation in the causes of non-adherence between patients and within patients over time A KEY CHALLENGE • Important to identify the reasons for each patient and tailoring interventions to these 1. Kardas P, Le
Slide 15: WHY ?
WHY ? Drivers of patient behavior 1 Health care professional behavior 2 Healthcare system factors 3 Proprietary and confidential — do not distribute GLO2208851 | Oct-21 | 15
Slide 16: Healthcare professionals (HCPs) and Adherence
Healthcare professionals (HCPs) and Adherence Lack of awareness of extent of problem 1 Often do not check adherence (when treatment is not working) If adherence is checked – then question is asked in way which results in “false” patient response 2 No better than chance at rating adherence of individ
Slide 17: WHY ?
WHY ? Drivers of patient behavior 1 Health care professional behavior 2 Healthcare system factors 3 GLO2208851 | Oct-21 | 17
Slide 18: Healthcare system barriers to managing non-adherence in routine care (OECD, 2018)
Healthcare system barriers to managing non- adherence in routine care (OECD, 2018) The problem of poor adherence to medication has generally been overlooked and rarely explicitly included in national health policy agendas. Consequently, few OECD countries routinely measure rates of adherence to medi
Slide 19: The way ahead: Overcoming the barriers
The way ahead: Overcoming the barriers NEED TO TARGET THE BARRIERS, WHICH CURRENTLY EXIST FOR : Health care professionals Patients & carers Health care systems GLO2208851 | Oct-21 | 19
Slide 20: HCP barriers to managing non-adherence in routine care
HCP barriers to managing non-adherence in routine care • Outside their remit “Not my job” • Underestimate prevalence • Approach non-adherence in a “non-friendly” manner • Ill-equipped to manage the reasons underlying non-adherence • Lack of time in routine appointments GLO2208851 | Oct-21 | 20
Slide 21: Patient barriers to managing non-adherence in routine care
Patient barriers to managing non-adherence in routine care • Hiding non-adherence from the clinician • Not wishing to disappoint or get “told-off” • Defensive - in response to direct questioning re adherence • Motivational and opportunity factors rarely addressed GLO2208851 | Oct-21 | 21
Slide 22: Implications for intervention development, training & clinical care
Implications for intervention development, training & clinical care Need to increase awareness of the extent and effect of non-adherence to medicines and other advice 1 – “a major public health problem”. Need to use patient friendly/collaborative ways of asking about adherence in consultations. Need
Slide 23: The future
The future More sophisticated Digital interventions Digital/HCP hybrid interventions based on: (with & without AI) 1,2 systems. • In-depth understanding of the individual drivers of non- adherence • Application of personalized, effective behavior change interventions 1. Babel R et al. AI solutions t
Slide 24: Pre-congress survey
c]) a:care Abbott Pre-congress survey
Slide 25: A:care pre-congress survey – 6157 participants
A:care pre-congress survey – 6157 participants 1. HOW GOOD IS YOUR UNDERSTANDING OF THE REASONS 3. HAVE YOU EVER USED BEHAVIOR CHANGE TECHNIQUES WHY PATIENTS ARE SOMETIMES NON-ADHERENT TO THEIR WITH YOUR PATIENTS BEFORE TO IMPROVE THEIR MEDICATION?? ADHERENCE TO MEDICATION? 3045 3658 1620 1806 1302