Adherence Equation: The Code is Cracked!

Previously in Pharm Exec, we discussed the two basic roadblocks to effective problem solving in advancing the goals of patient adherence programs: 1) failure to define the problem at base; and 2) looking for the solution in the wrong place. This month, let's take a deeper look into the solution and how we can capture it so the organization can proceed to solve the problem around a set of tangible actions.

Andrea LaFountain

Many solutions look and feel great—but how can a pharmaceutical company determine, using evidence, what will actually work and what won't before committing resources? Physicians have a clear rationale for choosing an appropriate treatment for a particular condition—usually a product that has a mechanism of action (MOA) directly purposed to interfere with the natural course of disease progression. What if marketers had the same rationale for their choice of interventions? Is it even possible for an adherence program to have an MOA that operates against a prespecified mechanism of disease?

A Justifiable Spend?

A significant barrier to solving the adherence challenge is the reliance on traditional market research and overzealous agencies pushing for execution long before (if at all) the fundamentals of the behavior have been specified. Human cognition is rocket science, of sorts! A better business model involves working with health economics and outcomes researchers, psychologists, social workers, nurses, economists, and business insights before transitioning to the commercial team for strategic deployment and program design.

Taking adherence out of the creative agency space and housing it where it rightfully belongs—in the sciences—will provide much-needed advancement in progressing this important field of study. We wouldn't put a brand manager or agency partner in a race car and ask them to design an intervention to make it go faster, or run more efficiently, and then leave them to brainstorm the options? They may have the idea to paint the car red—data suggests that red cars are faster, and any car would look faster in hot chili pepper red. But after three months in market, our red-hot car would still be struggling to make 500 horsepower. We would likely generate solutions with engineers and product designers who would provide ideas based on the aerodynamics of design and the laws of motion. That way, we would be confident that the solution offered is operating against a known MOA.

Why in the adherence space do we not employ such rigor? Why do we continue to direct significant resources to adherence initiatives year after year despite not having the blueprint for the design?

In my September Pharm Exec column ("Finding the Right Behavior Solutions"), I presented the concept that decision making is as rigorous a field of study as other sciences and one that lends itself particularly well to the application of mathematics. Every decision that we make, be it rational or irrational, conscious or subconscious, labored or instant, has a specified argument around it that is measurable. The keys to understanding the decision making process, including cracking the adherence code, are 1) understanding what factors drive the decision; 2) sensitively measuring them to assess contributory impact on the ensuing behavior; and 3) effectively manipulating the factors to create the decision behind the desired behavior.

That is, in order to secure a radical and sustainable impact on adherence, we need to be able to specify the mathematical argument around the MOA before we can attempt to create appropriately aligned interventions. And the good news is the equation does indeed exist in numerical form, as illustrated below:

P(Y) = [exp(Σßixi)/(1+ exp(Σßixi)]

Where:

Y = What we are trying to solve for—adherence

x1/xn = The causes of non-adherence

ß1/ßn = The weightings of each of these causal variables

Designing Interventions

These factors can cover a very broad range of psychosocial factors. For example, depending on the disease category, our experience, consistent with the literature on cognitive science, suggests that the value proposition of adherence may not be that strong when weighed directly against the value proposition of the alternative, which is non-adherence. And self-efficacy, a phenomenon that has featured heavily in clinical behavior modification programs for decades, may well be a better bet than a copay assistance program. These causal psychosocial factors provide a firm strategic and scientific platform for tailored interventions. Furthermore, with each new causal factor incorporated into the design, the opportunity for more ROI increases.

This article is not intended to specify a list of rank-ordered factors and their relative predictive power towards adherence; rather it is intended to provide an argument for pursuing a scientific adherence strategy. Knowing that these causal factors exist, and that they are fundamental as a foundation for your adherence strategy, is the lesson for today.

So take heart in knowing that scientific progress in the adherence space is being made:

» Yes, there are underlying cognitive factors behind the decision;

» Yes, these factors can be scientifically constructed;

» Yes, there are mathematical maps of adherence

» Yes, they provide a critical tool for brand ma;nagers to effectively design and execute interventions; and finally

» Yes, they provide a framework for CFOs to assess ROI and determine appropriate investment in adherence.

In my final column, we will review some principles of adherence from the scientific perspective, such that brand teams will be able to discern the difference between what looks and feels like a good investment and what truly constitutes a scientific business model to managing the adherence problem.

Andrea LaFountain is CEO of Mind Field Solutions. She can be reached at andrea.lafountain@mind-field-solutions.com