Table of Contents
- CHAPTER 1 EXECUTIVE SUMMARY
- Scope of the report
- Key findings
- CHAPTER 2 THE PROBLEM OF NON-ADHERENCE
- Evolution of the issue
- Defining adherence
- Compliance
- Persistence
- Concordance
- Adherence
- Identifying non-adherence
- The impact of non-adherence
- Factors affecting adherence
- Filling and refilling a prescription
- Moving past seeing adherence as solely the patient' s problem
- Societal, cultural and economic
- Socio-economic status
- Culture and religion
- Age
- Disease and therapy
- Diabetes therapy
- Hormonal contraception
- ADHD therapy
- Antidyslipidemics
- Healthcare system
- Treatment team
- Patient
- CHAPTER 3 DISEASE MANAGEMENT
- The growing importance of managing chronic disease
- Cases of chronic disease are on the rise
- Obesity
- Tobacco use
- Alcohol consumption
- Sicker patients are living longer
- The rise in the cost of healthcare is not sustainable
- Disease management is a shared responsibility
- Payers
- Pharmaceutical companies
- Patients
- Society
- National approaches to disease management
- United States-government programs embrace personal responsibility and
pay-for-performance initiatives
- Medicaid and Medicare are both government-run healthcare assistance
programs, with several key differences:
- Medicare is a federal public health insurance system that pays for
health services, including doctors' visits and hospital care.
Individuals must be at least 65 years of age or disabled to be eligible
for coverage.
- Medicaid' s ' personal responsibility' reward programs may negatively
impact adherence rates
- Medicare' s Health Support program focuses on improving outcomes
while cutting costs
- United Kingdom-physicians are incentivized to focus more on adherence
at the point-of-care
- France-legislature decides that pharmaceutical-sponsored adherence
programs are essentially advertising
- Singapore-leading the way in the management of non-communicable
disease in Asia
- Collaboration between stakeholders
- Treatment teams and patients
- Time-pressed physicians can leverage online resources to provide
patients with information and support for many of the medications they
commonly prescribe
- Nurses and pharmacists are ideally placed to play a bigger role in
patient education and support
- Case study: NHS Direct
- Case study: Asheville project
- Patient-employer (US-specific)
- Patient-patient
- Case study: www.CancerCompass.com
- Patient-pharmaceutical company
- Case study: The Bipolar Adherence Program for Seroquel
- Common program models
- Support for patients who are capable of self-management
- Support services for patients who struggle with adherence
- In-person support/visits
- Call centers
- Online and mobile programs
- Caregiver support
- CHAPTER 4 PHARMACEUTICAL INDUSTRY-SPECIFIC CONSIDERATIONS
- Adherence through the lifecycle of a drug
- Clinical trials
- Pre-launch and market entry
- Market expansion and maturity
- A role for electronic prescribing in adherence
- CRM offers pharmaceutical companies a tool to tackle adherence
programs
- Branded and non-branded pharmaceutical-sponsored disease management
programs
- Pharmaceutical company-sponsored disease management and drug adherence
programs
- Considerations when developing a drug adherence and disease management
strategy
- Regulatory considerations-when is disease management marketing?
- The language of adherence-why is patient-friendly communication
important?
- CHAPTER 5 THE FUTURE OF DISEASE MANAGEMENT AND DRUG ADHERENCE
- Suggested strategies to improve adherence
- Low tech-e.g., compliance packaging
- Mid tech-e.g., integrated online and offline programs
- High tech-e.g., merging compliance data into patient health records
- Drug adherence and disease management-present problems and future
directions
- CHAPTER 6 BIBLIOGRAPHY
- Cited publications and online articles
- Further reading
- Datamonitor resources
- APPENDIX
- Definitions and abbreviations
- Currency Table
- Extended methodology
- List of Tables
- Table 1: The terms ' adherence' , ' persistence' and ' concordance' are
believed to be more accurate terms to describe patient behavior, but
remain underused
- Table 2: Prevalence of lifestyle factors that contribute to chronic
non-communicable diseases in key markets
- Table 3: Medicare Health Support Pilot Programs in eight regions
across the US
- Table 4: The market for online and mobile adherence and disease
management solutions continues to expand
- Table 5: Research and development expenditure continues to rise
globally, particularly in the US market
- Table 6: Average 2006 exchange rates
- List of Figures
- Figure 1: The language used to describe adherence is critical to
creating a clear understanding of the issues surrounding treatment
- Figure 2: In both the Journal of the American Medical Association
(JAMA) and the British Medical Journal (BMJ) the term ' compliance' appears
less frequently in published papers than it did several years ago
- Figure 3: 1-year rates of persistency vary considerably depending on
the definition of persistence applied to a patient
- Figure 4: Relying on self-reported levels of adherence at the
point-of-care leads most physicians to significantly over-estimate patient
adherence and persistence with treatment
- Figure 5: Non-adherence is a shared problem among many
- Figure 6: Causes of non-adherence can originate with either the drug
therapy or the patient
- Figure 7: Current estimates assume an approximate 50% adherence rate
to prescribed medications in developed markets, but this does not ensure
that medications are being taken as prescribed
- Figure 8: Adherence is an extremely complex issue involving several
layered factors, many of which are outside of the control of patients
- Figure 9: Most patients are unintentionally non-adherent
- Figure 10: Due to the rise in obesity, diabetes and diabetes-related
complications are among the more significant burdens on the US healthcare
system
- Figure 11: Advances in medicine have made it possible for patients to
live longer despite chronic illnesses - life expectancy across the seven
major markets, 1960-2006
- Figure 12: Per capita expenditure on health has risen dramatically in
the us since the 1990s
- Figure 13: Pharmaceutical companies can work with physicians to
provide patients with much-needed education programs and disease
management tools
- Figure 14: The nurses that staff the NHS Direct telephone lines
provide patients with a range of support services and information
- Figure 15: Local pharmacists are ideally positioned to serve as
points-of-care for patients at risk for non-adherence
- Figure 16: Pitney Bowes provides a model for how employer investment
in preventive care and fostering adherence can result in cost savings over
time
- Figure 17: Online patient support is positioned to become a key factor
in treatment choice and persistence in several therapy areas requiring
long-term treatment and caregiver support
- Figure 18: AstraZeneca' s website is notable for the
variety of patient support tools it provides
- Figure 19: AstraZeneca' s website provides an
international audience with information and resources related to bipolar
disorder
- Figure 20: Most patients are capable of some degree of
self-management, but would still benefit from access to support services
- Figure 21: Disease management interventions aimed to help caregivers
have little impact on caregivers' levels of depression or quality of life
- Figure 22: Pharmaceutical companies should begin to consider
approaches to drug adherence and disease management early in the lifecycle
of a drug
- Figure 23: The traditional paper-based prescribing process presents
patients with many challenges to adherence and persistence
- Figure 24: Eli Lilly' s HealthInsights for Women provides online
resources for patients and healthcare professionals
- Figure 25: GSK' s Adherence Starts with Knowledge (ASK) program focuses
specifically on the importance of adherence to treatment in chronic disease
- Figure 26: The pharmaceutical industry must take care to communicate
with patients and caregivers in a way that increases their understanding
of adherence
- Figure 27: The unique design of PocketPak, which includes a fold-out
instruction leaflet, allows for the inclusion of a large amount of
information for patients
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