The high level of nonadherence across all therapeutic categories is a hot topic, and becoming hotter. It’s a question of enormous cost on one hand (to patients, insurers, CMS, hospitals, families…) and a serious question of lost revenue for the pharmaceutical companies. The team at BuzzBack has been working on nonadherence related issues for a number of years, and we utilize our tools to interpret how patients with a given disease understand and feel about what, exactly, they are going through.
In that light, a recent article in the New England Journal of Medicine by Lisa Rosenbaum, M.D. caught my attention. Dr. Rosenbaum, who writes on medicine for many publications and is a cardiologist at the University of Pennsylvania, explores how patient feelings impact adherence to medication for cardiovascular disease. The author cites a study that suggests that “one way to address medication avoidance is to better communicate the benefits of a drug. Although such communication is essential, so is the understanding of what beliefs contribute to avoidance of cardiovascular medications in the first place.” What’s exciting about that statement is that an increasing number of pharma companies are working with firms like us to dig deep into the “why” behind patient nonadherence. In fact, BuzzBack is currently working on a study (which we will present at the Pharmaceutical Market Research Conference on February 5) in which patients express feelings about their relationships with their doctor, their disease, and their therapeutic regimen, using visual imagery as well as direct questions. We are looking into how strongly positive and negative emotions can influence adherence, and whether it is related to usage of alternative medicine.
In her article, Dr. Rosenbaum recalls conversations with patients about why they abandon their regimens. She observes how some patients cite an interest in “natural” solutions. Patients see their prescriptions as “chemicals” to avoid – the drugs intrude upon the natural state of things. Other negative feelings and associations that reduce adherence include suspicion, shame, failure, aversion, fear of risk, and loss of control. Patients also say that today’s advanced medicine and its apparent speed of effect makes adherence seem less important (paraphrased as “I feel so much better leaving the hospital than when I came in – I don’t need to take the drugs anymore”). Related to that idea, patients who begin to feel better once on their own often become nonadherent. This is especially true for asymptomatic patients who lack concrete evidence of their improvement.
The article advocates what we often find when studying adherence. Pharma companies need to better articulate the purpose of their drugs to patients. They need to explain how both the obvious and unseen changes are both important. The article confirms what we have worked on for many years: visual metaphors and the visual delivery of this information can improve compliance. Dr. Rosenbaum writes about how patients on clopidogrel frequently explain why they take their medicine and what the benefit is to them. These patients use visual language (from Plavix ads) to paint the “here’s why I do it” picture: “It keeps my blood flowing. “It keeps the pipes from clogging.” The distinct visual lexicon creates a compelling mental image that seems to encourage adherence. Other research over the past 30 years has confirmed that visual imagery helps patients understand their disease better and adhere better to treatment. Rosenbaum proposes creating visual communications that make an emotional and personal patient-to-prescription connection that literally illustrates the purpose and benefits of the treatment. This begs the question: what visual metaphors can help companies outside Dr. Rosenbaum’s cardiology realm? How can visual and latent emotional insights improve diabetes adherence? Adherence with asthma therapy? What pictures should be included in communications that will ultimately improve and even save patient lives?
Dr. Rosenbaum’s conclusion echoes the spirit of BuzzBack’s mission when working with healthcare companies:
“Although we tend to view nonadherence as patients’ failure to know what’s good for them, learning about people’s feelings about medications has made me recognize that my ideas of good and bad were defined solely in my terms. What I’ve learned is that if I felt what they feel, I’d understand why they don’t.”
When innovating insights for pharma, we are driven to get at the why so we can influence better outcomes – often uncovering the visual language that will resonate profoundly with patients. As an insights professional, I often find those projects the most meaningful and memorable because they do the most good.
If you're interested in learning more about BuzzBack's own study on adherence, get in touch with us below.