When patients receive customized coaching to encourage therapy behavior modification, management of chronic conditions improves, and patients are able to conquer common challenges that hinder drug adherence.
Poor adherence to prescribed drug therapies is a persistent problem throughout healthcare. Half of all patients do not take their medications as prescribed and at least 125,000 Americans die annually due to poor medication adherence. It takes a personal toll on individual patients and imposes an enormous financial burden on the healthcare system. The use of behavior-based coaching strategies aims to inform and motivate patients to close the adherence gap, by addressing many of the most common barriers patients face when managing chronic healthcare conditions.
“When patients call our Contact Center, they are guided through an enrollment process, and part of that process involves offering the patient access to our coaching program,” explains Amanda Dean, PMP, Triplefin Account Manager. “We collaborate closely with the brand team, to develop tightly crafted survey questions and use the patient’s responses to determine their level of understanding of their medication therapy and underlying health condition.” The insight provided by the coaching survey results “gives the brand team a good idea of how adherent the patient is likely to be on the prescribed medication,” she adds.
“Triplefin partners with vendors who have developed scientifically validated surveys, and we tailor them to meet the objectives of the brand,” adds Dean. The coaching survey can be administered by phone, via a fax-back form, or online through the drug’s hub program.
Typically, the questionnaire involves approximately one dozen multiple choice survey questions, and the patient can choose from four different scripted answers. Each answer is carefully worded (and customized for the brand), so that the brand team can analyze the overall pattern of responses. The goal is to better understand the patient’s likelihood, reluctance or inability to remain adherent to his or her prescribed drug treatment regimen, and make other lifestyle-related changes needed to manage their chronic condition. Such lifestyle changes include things such as smoke cessation, increased exercise, weight loss and improved nutrition.
“Administration of these surveys allows us to identify patients who are at particularly high risk of poor adherence, so we can focus more coaching to support their health journey,” says Dean. She notes that patients with certain risk factors — for instance, those who have limited formal education or language barriers, a lower socio-economic status, or multiple co-morbidities — tend to have the highest risk of poor adherence, and thus tend to be most amenable to personalized coaching support.
Using a collaborative, case-management approach, each coach is assigned a group of patients, and detailed notes are maintained for every patient-coach interaction to ensure continuity from call to call, explains Dean. “Through the use of sustained, empathetic coaching, we are able to provide the right level of information, guidance, inspiration and support that the patient needs,” adds Dean. “It’s a very precious moment — that moment when we’ve connected with the patient and they’re willing to both hear from us and talk to us. We work hard to establish ongoing trust so they will continue to take our calls.”
Armed with a deeper understanding of the patient’s motivations and potential obstacles, the brand team can then tailor the type of coaching it provides over time, allowing for a very personalized form of support. “By administering the survey early on (once the patient opts into the program), and then again over time, we are able to track the patient’s behavior with regard to drug adherence and other lifestyle-related changes that may be required to support his or her overall treatment objectives,” says Dean.
Coaches: An economic option to a traditional call center
Many specialty drugs brand teams provide access to registered nurses and pharmacists who — through a call center — answer clinical questions related to the medical condition or prescribed drug product. This approach can be costly, and importantly, the type of interactions these clinical experts provide tend to be more formalized, focusing on drug-specific issues, but not necessarily addressing the many other issues the patient faces, such as nutrition or smoking cessation coaching.
By comparison, the use of trained behavior-modification coaches offers a cost-efficient alternative and another opportunity for patient engagement that can improve results. Through regular contact, these coaches develop a sustained relationship with their patients, encouraging and motivating them to undertake the behavior changes needed to improve diet and exercise, manage stress, quit smoking and adhere to prescribed drug regimens, to improve overall health outcomes and aid in recovery.
The coaches involved in this program typically speak to the patent in regular intervals over time, providing an empathetic and trusted form of support. “They will ask the patient ‘Do you fully understand how your medicine works, or what function it provides? Are you taking it regularly according to the doctor’s instructions?’” says Dean.
“We stress the importance of behavior modification, reading the drug’s boxed safety warnings, learning to read nutrition labels to keep track of sodium levels and calories — it’s the little things that count,” says Dean. “Some see these as common sense, but others see them as being very eye-opening, and helping patients to develop a deeper understanding can improve the number of days on therapy.”
Personalization is key
“We encourage patients who are managing a chronic health condition to identify personalized, long-term goals — such as seeing their child’s graduation or wedding, witnessing the birth of a grandchild, and so on — and then the coaches bring every conversation back to that goal,” says Dean. “The idea is that having a long-term, heartfelt goal will encourage patients to take the short-term steps needed to manage their disease and their treatment regimen, in order to improve overall health and longevity.”
“Our professional coaches give patients reminders and reinforcement, with a lot of respect and compassion,” adds Dean. “Sometimes that’s the missing piece that can significantly help move the needle for patients in terms of increasing the number of days on therapy and improving patient outcomes.”
Meanwhile, from the brand perspective, programs that are able to support successful, sustained use of products in the marketplace are essential to maximizing brand performance. Strong, real-world data related to improved health outcomes helps build confidence and support for the product among all stakeholders, including physicians, insurers and patients.