Enlisting patients in the drive to improve Rx

Nowhere is the need to engage more effectively with patients  more apparent than in the area of medication adherence.

“Over 50% of patients with chronic conditions stop taking their medications,” said Diane Gilworth, a geriatric nurse practitioner and chief clinical officer for Dovetail Health. “So we have to find a way to help patients take better care of themselves.”

The health system’s dismal record for effectiveness in getting patients to adhere to their drug regimens prompted GlaxoSmithKline to overhaul its approach to encouraging adherence and to create a new business unit, called the Patient Engagement Group.

“We were doing things like refill reminders and text messages. We’re really good at patient education, at pushing leaflets and alerts to patients. But with all those rational solutions, we were completely missing the irrational behavioral part of nonadherence,” said Christy Brown, a pharmacist who directs patient engagement efforts at GSK as head of insights and innovation.

“How do we get people more engaged and more active in their health? … That in turn will lead to better adherence,” she said.

In response, GSK shifted its marketing focus “from a very product-focused, information-based, one-way conversation to a more behavioral-based approach … and giving providers some tools,” Brown said.

“We have to get into patients’ homes and understand, on a very granular, detailed level, what those behavioral characteristics are that are driving patients not to take their medications,” she said. “If we can reduce the readmission rate and lower total medical expense, then people will understand there’s a value here. And they’ll be willing to pay for longitudinal care.”

That shift, Gilworth added, “is a very big change because we used to think of things in very tight financial time frames. We have to extend that now, probably beyond the 30-day readmission incentives.”

That broader, more holistic, longer-term focus on health and outcomes, she said, is already beginning to occur among accountable care organizations. “ACOs are beginning to … understand that we have to take care of people over the long run, and that behavior, particularly in chronic disease, waxes and wanes,” Gilworth said. “How do you stay engaged when you’re trying to figure out how to eat?”