Noncompliance Is a Curable Disease

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The rich promise of molecular medicine is being realized in powerful new prescription drugs that can delay or eliminate the need for surgery, hospitalization and years of chronic care for millions of Americans.


Yet, studies show that as many as 40 percent of patients do not comply with their prescribed treatments. Noncompliance is even more severe in such areas as hypertension and cholesterol reduction, in which as many as 80 percent don't adhere to their therapy. Examples of noncompliance behaviors include:


* Not obtaining initial or refill prescriptions.


* Taking incorrect doses.


* Stopping a medicine too soon.


* Mistiming doses.


* Consuming foods or beverages that interact with the medicine.


* Sharing medication with others.


* Failing to manage drug interactions.


* Not taking the medication at all.


There is a growing recognition that individual lifestyle choices influence disease in profound ways, yet healthcare providers have little time and few resources for adequate patient education. The pharmaceutical industry is faced with a classic marketing problem: How can manufacturers increase compliance and create mutual value in a three-way dialogue with providers and patients?


Nothing is as personal as your health: The nation's medical and public-health leaders have invested decades and millions of dollars on "generic" health-education programs with spotty results for two simple reasons: No two people are identical, and healthcare is an intensely personal business. Noncompliance is an individual problem requiring individually tailored solutions.


In the past, delivering individualized messages to members of large groups was too time- and cost-prohibitive to be practical. Relationship-marketing technologies, however, let healthcare manufacturers, insurers and providers deliver personalized patient-education and support materials tailored to match the health profile, needs and lifestyles of each participant. This can supplement the provider-patient relationship in ways that educate and motivate patients and move them toward a change in behavior.


At the heart of these new techniques is the premise that noncompliance is a modifiable behavior -- and no solution is more effective in enhancing poor compliance behaviors than two- or three-way interactive communication tailored to the individual and his provider relationship. Segmentation is not good enough in healthcare because each individual's gene map and environmental conditions are unique. Billions of possible message combinations exist in relatively simple programs. The integration of computer science with behavioral science now is capable of engaging the individual with unique solutions, not wasteful mass communication.


One-to-one relationship: The solution means tailoring the program based on the patient's heath profile, knowledge, beliefs, circumstances, prior experience, media preferences, lifestyle and provider direction where appropriate. The timing of information should be curriculum-based, allowing patients to move along the education continuum at their own pace. And by implementing feedback loops, a learning dialogue can be established with the patient, ensuring that the program will grow and change as the patient moves toward a sustainable change in behavior.


People act and react in everything they do based on individual preferences and issues -- and adhering to treatments and medications is no different. In healthcare, and in other industries for that matter, behavior change requires tools to motivate individuals to overcome personal barriers. Sophisticated relationship marketing software can present messages in ways that patients are most likely to act upon.


Another key success factor is letting patients choose how they receive their information. Some may prefer printed materials, such as newsletters, booklets, brochures and calendars, and others may want to receive their information from dynamic, personalized Web sites. By integrating these channels with call centers, e-mail and other media, programs can achieve new levels of interactivity and effectiveness. Location is no longer a barrier as programs can be delivered at home, the work site, the retail pharmacy and the doctor's office through one common infrastructure.


Above all, successful one-to-one marketing programs must ensure the privacy of personal information. Security measures must ensure that programs are voluntary and confidential transactions between the patient, provider and sponsoring organization.


Relationship marketing programs essentially offer a value proposition to patients -- if they provide personal data, the sponsor promises to deliver relevant, valuable information to help them self-manage their diseases. To maintain this trust, data must be used solely for the purpose for which it was collected and must never be sold to third parties outside of the patient's control.


Personalized treatment adherence programs are truly customer-driven -- they can't succeed without the active participation of the patient. This participation and the accompanying feeling of control it gives the patient is crucial to the successful management of disease. Patients who enroll are taking the first step to better health and tend to feel more responsible for achieving enhanced outcomes.


One-to-one treatment adherence programs can help realize the benefits of new medications by giving patients and providers educational tools capable of delivering appropriate, timely and accurate information in terms relevant to the individual. Noncompliance is a curable disease where everyone wins: patient, provider, manufacturer and society.


Steve Sloate is executive vice president of MicroMass Communications Inc., New York.
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