Physicians have an array of modern medications to prescribe to treat serious diseases and chronic conditions, medications that have proven their efficacy in rigorous clinical trials. Getting the best possible patient outcome, however, turns out to have as much to do with the patient as the medication itself.
In fact, 50% of health outcomes are determined by people’s behaviors – yet perhaps a third of patients fail to take their medications as prescribed, according to Dr. Isabelle Durand-Zaleski, Chief of Public Health at Henri Mondor Hospital in Paris. “In some cases, just half of patients adhere to prescribed treatments, making it important to find ways to create even modest improvements in adherence”, said Hayden Bosworth, a Professor of Medicine at Duke University.
“People often say we need to focus on patient education, but patient education is not enough,” said Dr. Anne Beal, Global Head of Patient Solutions for Sanofi. “That which truly enables patients to become healthy and enjoy positive outcomes lies in their own behavior and the way in which they manage their conditions.”
To find ways to address this problem, Sanofi is turning to experts in human behavior, like Bosworth and Durand-Zaleski. The two are part of an international panel of experts Sanofi has assembled to help the company understand the different factors involved in real-world compliance. The company is also working with high-tech companies specializing in analytics to add to that knowledge.
The ultimate goal is to transform the information to create patient interventions that will lead to greater compliance along a patient’s health journey and lead to better outcomes.
Researchers already understand that a large number of patients have significant challenges with taking their medications, filling their prescriptions, and other aspects of managing their treatment. The reasons are many. Some are as simple as patients who just forget to take their medicine. Other patients may be so busy with different demands on their time – parents trying to get their children to school and themselves to work in the morning – that they lack the time to follow their treatment plan.
At times, the reasons can be more complex, and can relate to what researchers call “contextual” issues – things like a person’s daily surroundings, their cultural background, geographic location, and socio-economic status.
Another significant factor in non-compliance is a patient’s level of “activation.” Patients who have a low activation score often feel they aren’t in control of their health situations, or that they can’t get their questions answered by their physicians. They are less likely to adhere to their treatment, Beal noted, while more “activated” patients show a greater ability to manage their condition and treatment.
Gathering “real-world” evidence on the behaviors that affect compliance is becoming easier with the advent of technologies such as electronic medical records and online access to claims data. Observational data from doctor-patient interactions, medical imaging and even social media are playing an increasingly important role in providing data about compliance.
“There is a tremendous amount of data available in the real-world,” said Dr. Bernard Hamelin, Global Head of Medical Evidence Generation for Sanofi. “All this information can help us measure the outcomes of relevance for the treatment that are of interest to us. It also helps us contextualise these outcomes.”
Sanofi also is collaborating with a range of companies for access to even more sources of data that can be used to understand how behaviors and compliance differ in patients from different countries or regions. New types of “big data” analytics are also part of these collaborations, allowing Sanofi to gain insights across many different data sets and types of information.
One of those collaborations is with a Silicon Valley company called Evidation Health, which has developed an innovative platform to quantify the impact of various real-world factors, including patient behaviors, on the eventual outcome of a course of treatment . The company collects a wide range of information from patients who opt-in actively to participate.
The system can be particularly helpful when it comes to chronic conditions like diabetes long-term care. For example, patients just beginning to take insulin for their condition can experience weight gain. In some cases, that will cause the patient to stop taking their medication. By using their system to track a patient’s weight, activity and pharmacy claims, Evidation can give doctors an indication of which patients are at the highest risk for noncompliance.
“Knowing that may happen and seeing the trend ahead of time, we can be much more proactive in providing education and care to those patients before they fall off the bandwagon,” said Christine Lemke, Co-Founder and President of Evidation Health. “We believe that we can help physicians monitor patients more effectively and be more proactive about care when they see the signals before the patients actually drop off. “
Researchers have also discovered that finding ways for patients with the same condition to interact with one another can significantly improve compliance. Sanofi panel member John Piette, a professor of health behaviour and health education at the University of Michigan, conducted a randomized study that showed diabetes patients who have peer-to-peer support have much better outcomes than those who only interact with medical professionals.
Finding ways to understand and change patient behaviors will become even more important as fewer new medicines come to market and the long-term cost of health care continues to climb, especially as chronic disease become more widespread. “Increasing adherence by just five or 10 percent”, Bosworth said, “would create improved health comparable to bringing a whole new medication on the market.”