29th May, 2024
“The relationship between the patient and the healthcare provider must be a partnership to which both parties must contribute in order to make it work.” - Dr. Alberto Hidalgo, a genetics specialist at the National Rehabilitation Institute in Mexico City.
Chronic diseases, such as diabetes, hypertension and cancer, among others, represent a major burden for health systems. The epidemiological shift in disease burden from acute to chronic diseases over the past few decades has rendered acute care models of health service delivery inadequate to address the health needs of the population.
Poor adherence to chronic disease treatments is one of the key drivers of health system burden. Adherence to long-term therapy for chronic illnesses in developed countries averages 50 percent. In low- and middle-income countries, the rates are even lower. It’s no surprise that healthcare providers have spent years looking at ways to ensure that patients comply with the prescribed treatment.
The impact of non-adherence grows as the burden of chronic disease grows worldwide. Consequences of non-adherence to long-term therapies are poor health outcomes and increased healthcare costs. That’s because poor adherence to long-term therapies severely compromises the effectiveness of treatment. This is a critical issue both for a patient’s quality of life and for health economics.
What is adherence?
The World Health Organization (WHO) defines adherence as “the extent to which a person’s behavior—taking medication, following a diet and/or executing lifestyle changes—corresponds with agreed-upon recommendations from a health care provider.”
Earlier, it was considered that either the patients themselves, their health providers, or both were the source of this non-compliance. Nowadays, there’s a better understanding that the adherence process is dynamic and complex. That is why ensuring adherence to treatment goes far beyond just remembering to take your medication. The ability of patients to follow treatment plans in an optimal manner is often compromised by more than one barrier, including social and economic factors, the healthcare team and system, the characteristics of the disease, disease therapies and other patient-related factors. Addressing these barriers holistically is key to improving treatment adherence.
Simplistic approaches to improve adherence to treatment may no longer be the right approach. But what is? Let’s explore some of these solutions.
Partnership with patients
According to Dr. Alberto Hidalgo, a genetics specialist at the National Rehabilitation Institute in Mexico City, “the relationship between the patient and the healthcare provider must be a partnership to which both parties must contribute to make it work.”
In other words, the quality of the relationship between the provider and the patient is a key factor in maintaining adherence. “Patients should be active partners with health professionals in their own care, and good communication between the patient and the health professional is a must for an effective clinical practice”, added Dr. Hidalgo.
A personalized approach
Silvia Mendez, Country Operations Lead, Mexico at Axios International, has seen first-hand that effective adherence solutions must take into consideration the many dimensions of adherence.
“It starts with a strong relationship with the provider, but once they leave their doctors office, there are many other issues introduced,” said Silvia.
“Affordability is still one of the most significant challenges for patients in adhering to their prescribed treatment. However, there are other factors at play, such as unexpected expenses related to their disease or treatment, lack of understanding of their journey from the initial stages of diagnosis to reaching the benefit of their treatment, and even limited transportation options for appointments,” she says, adding “Furthermore, medical appointments often have long wait times, and there are gaps in the referral network. These factors not only hinder patient compliance to treatment but also put increased pressure on the healthcare system as non-compliance often breeds new complications in a patient’s health.”
That is why it is critical to look at the patient journey holistically and provide tailored, personalized adherence interventions for each patient because each is different.
Adopting an evidence-based approach, Axios International’s proprietary Patient Needs Assessment Tool (PNAT) customizes services to each patient, thereby increasing adherence, engagement, and program cost-efficiency. The patient undergoes a personal needs assessment using PNAT to determine the support they need to stay on their prescribed treatment. By utilizing this validated scientific tool to assess and identify the unmet needs of the patient and understand the variations in adherence patterns and individual motivations, Axios is able to customize interventions to address the individual adherence needs of a patient, and in turn, maximize their medical benefit.
For instance, one patient may discontinue therapy due to intolerable side effects, the inconvenience of doctor visits, and apprehension about being reprimanded for non-adherence. Another patient with the same diagnosis may skip doses due to a demanding lifestyle, frequent travel, and a lack of comprehension regarding the severity of their condition. Recognizing these nuanced differences is pivotal in devising effective access strategies and solutions that cater to each patient's needs. Based on the results of the PNAT assessment, patients enrolled in an Axios Supported Program have access to a personalized treatment support plan that addresses their therapy-related and social-related needs. Personalized care recognizes each individual's unique circumstances, a key factor in achieving better health outcomes in long-term chronic disease management.
A multi-disciplinary approach to delivering personalized care
Adherence is a dynamic process and delivering personalized care requires a multi-disciplinary approach.
Healthcare providers should assess the patient’s readiness to adhere, provide advice on how to do it and follow up on the patient’s progress. However, healthcare providers often don’t have the time to address these individual challenges on their own, given their patient load and other responsibilities, especially in a pandemic situation where this was apparent. Access consulting and program partner Axios International can help complement their efforts by providing additional support to patients once they leave the facility, continuing to follow up with them even outside the hospital.
Social support received by patients from other members of their community is another important factor and has been consistently reported as an important driver of health outcomes and behaviors.
To overcome growing treatment adherence barriers, a stronger commitment to a multidisciplinary approach is needed. This will require coordinated action from healthcare professionals, policymakers, patient support groups, communities and patients themselves.
Adhering to treatment improves patient outcomes, leading to better health, reduced symptoms, and increased quality of life. Societally, it lowers healthcare costs, reduces disease spread, and enhances overall public health and productivity.
