Successful disease management is a team sport. However, there is one player that needs to shoulder the greatest responsibility in order for the team to win in the long term: the patient. Although physicians and other care providers should encourage adherence to treatment regimens as much as possible, their typical 15-minute time slots — filled with multiple priorities — dictate a fundamentally limited role.
Plus, how often does a patient see his physician? It's difficult for a physician to serve as primary motivator of important daily routines, such as diet, exercise, medication adherence and compliance, with other medical regimens on an annual or quarterly basis. Physicians can only do so much. And, speaking as a physician myself, I must admit that some healthcare providers are simply more effective than others in their motivational skills.
So what can be used to fill the void that professionals cannot, and will never, fill? Luckily, with recent advances in online and wireless technology, in concert with an increasingly sophisticated science of human motivation and consumer psychology, innovation in disease self-management can now provide the patient-as-consumer more effective touch points than ever before.
These new and emerging innovations represent a valuable opportunity to make a bigger dent in self-management than the first-generation solutions that came before them: reminder-based phone calls and mailings, simple cost-reduction strategies and traditional (often boring and short-lived) educational efforts.
Consider one important facet of disease self-management: adherence to prescription medications. Poor adherence to medications for chronic conditions is one of the most serious and costly problems in healthcare. According to a 2009 report from the New England Healthcare Institute, medication non-adherence accounts for an astonishing $290 billion in otherwise avoidable medical spending per year due to complications from chronic disease.
Surprising to many, non-adherence affects virtually every condition — from hypertension to acne to oncology — and virtually every demographic, including the well-educated and wealthy. Here's why: It's a problem largely rooted in a combination of human irrationality and insufficient motivation — universal human shortcomings.
Clearly, it's not rational for a transplant patient to quit taking immunosuppressant medication, given the specter of organ rejection (non-adherence is a leading cause of rejection of kidney transplants). It's not rational to stop refilling drops for glaucoma given the risk of blindness. And yet people do stop taking these medications, in striking numbers.
There are a number of less-than-rational reasons that people stop taking their medications: They don't want to feel old, or be reminded that they are a patient with a condition, or put up with annoying yet transient side effects, or be inconvenienced by long lines at the pharmacy. More to the point, it's exceedingly difficult for many people to maintain the motivation to take a medication today, tomorrow and the next day when the benefit may be years away. Humans crave more immediate gratification. In a word, medication non-adherence is largely a value problem. Despite the long-term benefits, patients often don't perceive sufficient short-term value in their medications.
From both a medical and a business perspective (as an entrepreneur in the medication adherence space), I feel strongly that what we need are compelling solutions to motivate patients to stick with their medications. In particular, we need solutions that can enhance even the short-term value proposition of a medication in the mind of the patient-as-consumer.
Such solutions should certainly incorporate the greatest hits of prior efforts — education and reminders — but with a twist, delivered in a more effective, fun and frequent format such as via online and mobile solutions that a patient can access at their convenience.
In addition, given the abundance of valuable insights from disciplines such as consumer psychology and behavioral economics — insights already well leveraged in the consumer world outside of medicine — modern solutions should also consider incorporating creative incentives and even gaming dynamics to maximize their motivational impact. In other words, a combination of both extrinsic and intrinsic motivators will be most effective in encouraging both short-term and longer-term adherence. And, adding a little of the “fun factor” can't hurt. Healthcare could use a little more fun.
Katrina S. Firlik, M.D., is co-founder and chief medical officer of HealthPrize Technologies.
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