I am an experience design professional and below is a (slightly) modified version of a blog entry I posted on my company's website a few weeks back. I'm curious if other design/healthcare professionals are seeing the same themes bubble up in terms of patient adherence challenges and opportunities for segments of the healthcare industry to better support adherence - it's a big topic, but hopefully it'll get some conversation going.

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Why don’t patients follow their doctor’s orders? Why do they fail to adhere to the prescribed behaviorial and/or medication regimens they know can help them maintain or regain their health?

I think it’s time to start working collaboratively on answers. There are multiple disciplines currently looking at the changing face of the US healthcare system holistically as well as facet-by-facet... My experience design colleagues and I are constantly looking at the experience of being a patient (or healthy person) and are finding there is a lot of opportunity across the industry for collaboration on supporting treatment and wellness maintenance regimens.

Drawing on insights gained from several research projects involving primary patient research, we are noticing the following themes in the reasons given for why patients fail to fully adhere to the regimens their doctors prescribe.

Lack of understanding of adherence and compliance – patients and caregivers do not always fully understand adherence or compliance, and do not always understand their behavior’s impact on treatment efficacy and overall health.

Lack of incentives and motivation – remaining or becoming healthy should be enough incentive to adhere to treatment and wellness regimens, but patients often require significant evidence or instant results to reinforce changes to their behavior. How many of us have started an exercise regimen just to get frustrated and drop off after a month? Especially for conditions that can be asymptomatic, such as heart disease, or conditions that are not necessarily considered severe, such as acid reflux, seeing the benefits of adherence and maintaining motivation can be a challenge.

Lack of support – once patients receive a prescription or receive instructions on required behaviorial changes, they can feel alone, especially if the regimen is complex. They must take action, often with limited resources or tools and without even someone credible they can trust for guidance, emotional support and information. The effort can feel overwhelming.

Lack of transparency and accountability – patients, first and foremost, are responsible for their behavior, but who else has a stake in their adherence? Who should be monitoring their progress? Their physicians assume responsibility when it’s check-up time, but who should be responsible between visits? And even during a check-up, when it comes to adherence and identifying the challenges and addressing them, the physician most often relies solely on patient self-reporting. Is it reasonable to assume this process can ensure the best outcome?

Too much assumption – speaking of assuming, it happens a lot on the part of the patient, the physician and the other players in the system. Patients can make many assumptions, such as that a medication is enough without accompanying life changes. Physicians often assume that once they have given treatment instructions to a patient the patient understands, or at least knows where to turn for additional credible information. Hospitals, pharmacies, and insurance companies often assume patients have the necessary knowledge and resources to successfully finance and coordinate care, filter through health and wellness information, and maintain treatment regimens.

These themes may not sound like anything groundbreaking, but they bring to light additional valuable questions.
- How do different roles view these barriers to patient adherence?
- Is what patients view as being their greatest barrier to adherence the same as what physicians, insurance companies and pharmacists view as being the greatest barrier?
- What would it take to tackle each of these barriers?
- What are the opportunities across the industry to better support patient adherence?

While there is still a lot to explore, there are certain areas for opportunity that are rising to the top – here are some initial thoughts:

Physicians – as the US healthcare system evolves, physicians will have to define their role as not just a healer or a gatekeeper to treatment, but as a proactive health educator and facilitator, thinking of patients holistically. (See JMH’s post on Personal Healthcare Strategists). In order to accomplish this, physicians will need the support of hospital networks, insurance companies and technology providers.

Insurance Companies – they already have the incentive to keep people healthy, but they are not fully taking advantage of the touch points they have with their customers. Wellness programs need to be better designed to facilitate patient adherence. Incentives, third party partnerships, facilitating information gathering, and the provision of meaningful and easy-to-use tools are areas for opportunity.

Pharmaceutical Companies – pharma already diligently produces condition information through unbranded and branded outlets. However, there is an opportunity for pharmaceuticals to partner with physicians by expanding their unbranded information outreach efforts. Patients and caregivers are reluctant to trust pharmaceutical companies when information is provided through their marketing channels; however, they trust information that is thorough, credible and delivered through channels perceived as being unbiased. There is an opportunity for pharma to deliver its research-based evidence transparently through trusted information channels.

Pharmacies – big name pharmacies are quickly evolving from being a place only for medication retrieval to being a resource that focuses on customer service and provides information, as well as select treatment and preventive services, such as flu shots. Among many opportunities for pharmacies is the improvement of their communications and processes with physicians and insurance companies. They have a unique opportunity to step in on the side of making medication adherence easier.

There are many more opportunities to discuss, including opportunities for patient support networks, government sponsored programs, and services provided by commercial third parties ranging from local fitness centers to emerging social media tools. I want to open up the conversation - from your perspective, what do you think are the biggest opportunities? Who is involved?