A study published recently in JAMA Internal Medicine showed financial rewards and connected pill bottles don’t work. One explanation suggests that “other patient concerns about potential adverse effects of these medications, such as impotence or fatigue, were not targeted by this engagement strategy.”
How can a patient engagement strategy not target the patient’s concerns? Isn’t that the very definition of patient engagement? Impotence and fatigue are a big deal to most people. Would an extra $15 a week compel you to take a medication that made you impotent? $150 a week? Would a pulsating pill bottle in your cabinet get you to swallow a pill that made you feel foggy and tired all day?
We can’t incent or remind someone to do something they never agreed to or intended to do. It would be like Amazon pinging you to buy something you would never consider adding to your cart. Amazon nudges you to buy things that you would put in your cart or things you saved to your cart, but never purchased. Why aren’t we as laser-focused on what matters to patients?
Obama’s most significant healthcare-related accomplishment this year may well have been his campaign’s demonstration of the effective use of analytics and behavioral insight – strategies that also offer exceptional promise for the delivery of care and the maintenance of health.
For starters, of course, there’s the widely-reported “big data” success of the Obama campaign. In unprecedented fashioned, they collected, mined, analyzed, and actioned information, microtargeting voters in a remarkably individualized fashion.
Imagine if healthcare interventions could be personalized as effectively (or pursued as passionately).
Another example: according to the NYT, the Obama campaign hired a “dream team” of behavioral psychologists to burnish their message and bring out the vote, using a range of techniques the field has developed over the years.
According to the article, the behavioral experts “said they knew of no such informal advisory committee on the Republican side.”
This idea of focusing intensively on behavior change is without question an idea whose time has come.
Earlier this year, for instance, a colleague (with similar training in medicine, molecular biology, and business) and I were surveying the biopharma landscape, and were struck by the extent to which classic biology hasn’t (yet) delivered the cures for which we had hoped; physiology turns out to be extremely complicated, and people, and communities, even more so.
We were also struck by the remarkably low adherence rates for many drugs, abysmal whether you look at this from the perspective of clinical care or commercial opportunity (imagine if Toyota lost half their cars on the way to the dealership).
You are sick with something-or-other and your doctor writes you a prescription for a medication. She briefly tells you what it’s for and how to take it. You go to the pharmacy, pick up the medication, go home and follow the instructions, right? I mean, how hard could it be?
Pretty hard, it appears. Between 20 percent to 80 percent of us – differing by disease and drug – don’t seem to be able to do it.
There are, of course, many reasons we aren’t. Drugs are sometimes too pricey, so we don’t fill the prescription. Or we buy them and then apply our ingenuity to making them last longer by splitting pills and otherwise experimenting with the dosage.
Some drugs have to be taken at specific times or under specific conditions, posing little challenge when you are taking only one. But it can be devilishly difficult to coordinate the green pill half an hour before breakfast, the yellow ones on an empty stomach four times a day and the orange one with a snack between meals. It’s complicated; we don’t understand. We’re busy; we forget. We’re sick; it’s confusing.
Some drugs produce uncomfortable side effects while others set off an allergic reaction. Every single day, we have to decide if the promised outcomes are worth the discomfort.Continue reading…