Improving medication adherence through a collaborative approach with the CfBI Medical Adherence and Digital Health consortium

Abbott is proud to work with CfBI Medical Adherence and Digital Health consortium, which brings together powerful stakeholders and decision makers from across healthcare encompassing organizations from the pharmaceutical, pharmacy, contract research, technology, patient advocacy, insurance, and health care professional sectors – advised by leading academics. This is taking a collaborative pan industry approach to the expensive problem of poor adherence to treatment regimes. The group is also interested in understanding and addressing some of the underlying issues surrounding the opportunities and obstacles associated with digital health, especially as it can support increased adherence and patient engagement.

The group is pursuing a number of themes.

• Economic Sustainability of Medical Adherence. This theme resulted in the production of a position paper (“Encouraging adherence initiatives: aligning individual, commercial, and social value”¹ – available here) which has been used to facilitate high level discussions with some of our members.  The paper sets out why medicines adherence is difficult to achieve, describes the barriers that limit success, and identifies where efforts should be concentrated to improve adherence. In particular, the need to address ‘value misalignment’ on low-cost high-volume medicines, where low prices dis-incentivize manufacturer funded adherence programs, though the cost and impact of non-adherence to the payer is significant because of the high volume.  The consortium concludes by making five recommendations to policy makers, payers, healthcare professionals and manufacturers to recognize adherence in the development of policies and new services, to discover new ways of funding adherence, and to use existing funding more effectively. CfBI is developing this theme by investigating possible business models and partnerships that might enable more sustainable adherence initiatives.

“Policymakers and influencers should concentrate on addressing the area of greatest economic value misalignment for adherence initiatives – namely where the volume of prescriptions is high, and cost of drug is low – and focusing on those medications and conditions where non-adherence is considered a significant problem.”

• Adherence and Digital Health. CfBI believes that the emergence of pervasive digital technologies in healthcare present the opportunity to increase personalization of care, relevance of therapies, and hence better patient engagement (and improved adherence). Two working groups have been set up. Behavior Change Techniques: The agreement (amongst consortium members – and guided by our academic members) of the most promising recognized behavior change techniques in terms of their effectiveness and scalability through digitalization. A framework that enables apps to be characterized according to the causes of non-adherence they aim to address has been created and will shortly be published. Measurement of Adherence: In order to ensure that information systems can exchange adherence information meaningfully, definitions and measurement methods need to be agreed. This working group is focusing on the measurement of adherence. Initial work of this working group is the identification and agreement of information and definition standards for adherence – and identifying the common ‘biases’ in the reporting of adherence and simple steps that can be taken to address these. The work will result in a simple adherence measurement bias checklist that practitioners and reviewers can use to ensure that reported adherence claims are credible.
• Adherence in Clinical Trials. CfBI’s ‘mission’ here has been to promote and champion the routine measurement and reporting of adherence in clinical trials. The group has drafted a companion paper to the recently released EMERGE (ESPACOMP Medication Adherence Reporting Guidelines) trial reporting guidelines. The paper discusses practical considerations and recommendations for the effective measurement and reporting of adherence in trials and has been published in the British Journal of Clinical Pharmacology² (available here).

The self-funded group meets quarterly to agree and progress its goals through structured workshops and ‘expert witness’ presentations. The size of the group is restricted to ensure that discussions are focused, efficient, and (as Chatham House rules – no attribution – are observed) honest and meaningful. Between meetings, work is conducted by delegated working groups led by key industry figures.