ADHERENCE INSIDER
Merck's Dr. Colleen McHorney's Real-Life Approach to Patient
Adherence Research
Dr. Colleen
McHorney |
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Interviewed by Frank Smith
Managing Editor, eBulletins
Frost & Sullivan |
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In March 2011, a high-level group of approximately
60 executives and thought leaders from across the healthcare industry gathered in Philadelphia to explore new ideas to successfully address the quickest way to reduce healthcare costs: increasing patient adherence to medications prescribed for their existing health conditions. The sessions provided a wide variety of perspectives on the issues impacting medication adherence, and were lively in the exchange of ideas, both from speakers and the audience.
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To address this issue, in October, 2011, Merck added medication adherence resources to its comprehensive wellness website — MerckEngage.com. The resources are designed to help consumers stay on course with their treatment and have better conversations with their health care professionals about the medicines they have been prescribed. One of the resources, the Adherence Estimator® is a one-minute survey tool for patients who have been prescribed a new medication for a chronic condition. Designed by Dr. McHorney, the Adherence Estimator can be used to help estimate how a patient's attitudes and feelings about their newly-prescribed medication may impact their adherence to that treatment.
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“Patrick Witmer, Director, Global Human Health Communications, U.S. Market, Merck & Co., Inc. says, “One of the reasons [the Adherence Estimator] has been well received by health care professionals is because of its simplicity.” |
In a conversation with Frost & Sullivan, Dr. McHorney outlined the fundamental research that went into the creation of the Adherence Estimator as well as some of the high-level issues behind patient adherence.
Frost & Sullivan: What was your research process behind Merck's Adherence Estimator?
Dr. Colleen McHorney: I've been creating patient-centered tools my entire career. My approach in developing the Adherence Estimator was the same as what I've done for all of my research: I go out and talk to real-life people. There are some investigators who create instruments who have never spoken to a patient about their experiences with chronic disease and prescription medications. Over the past five years, I've spoken to almost 1,000 patients with chronic disease. I conduct focus groups to understand the consumer perspective on why people do and do not take their medications. To create the Adherence Estimator…, I tested 150 questionnaire items in almost 2,000 patients and winnowed down the 150 items to three (the 3C's – Commitment, Concerns, and Costs) using psychometric techniques. I replicated the salience, relevance, and the primacy of those "3C's" in 83,000 patients with chronic disease.
Frost: Can you explain what the Three Cs are?
McHorney: The 3C's are the three principal drivers of non-adherence in our research. The first and most important C is commitment or conviction — we call it perceived need for medications. The second is concern, including perceived medication concerns, which include side-effect concerns, addiction concerns, and dependency concerns. The third C is cost, or perceived medication affordability.
Frost: How does the Adherence Estimator address these issues — the 3C's — that are typical barriers to non-adherence?
McHorney: In terms of basic research, we conducted a series of studies with George Mason University with world-renowned health communication investigators to better understand the ways to approach messaging around the 3C's. We've examined whether it matters if you frame adherence communication negatively or positively. Message framing has been studied extensively in many types of health behaviors from sunscreen use to wearing condoms to cancer screening. The results have been largely mixed. We formally tested whether positive versus negative message framing makes a difference -- not in terms of adherence -- but in terms of the chronically ill patient's intention to adhere. We found that both frames resonated equally well.
The second study tested whether present versus future framing makes a difference. As human beings, we all procrastinate, and we tend to discount things that occur far in the future (such as a myocardial infarction or a stroke). We formally tested whether messages that focused on present vs. future rewards and consequences resonated differently with consumers with chronic disease. We found that they resonated equally well, which was good news because of the difficulty of messaging effectively about short-term consequences for people who are prescribed medicines for long-term chronic disease.
Frost: What factors do you think are important to improving adherence?
McHorney: After more than 40 years of research and 40,000 articles, most research and most interventions have focused on the patient and ignored the physician's role, the pharmacist's role, and the healthcare system's role in adherence. We need to start conceptualizing and executing multi-factoral and multi-level research. It is possible to segment patients on their propensity to adhere, like with the Adherence Estimator, but there is published research that suggests that some physicians have lots of high-adhering patients and some physicians have lots of low-adhering patients. Many healthcare organizations have this data, and they could look at adherence at the physician level and then investigate what it is about the physician or the office or the practice that yields lots of high-adherence patients or lots of low-adherence patients. A colleague of mine who is a clinician says that if you intervene at the patient level and you change one patient, you can change one patient. If you intervene at the physician level and you change the way a physician communicates and prescribes and interacts, you can changes hundreds — if not thousands — of patients.
To read an extended version of this conversation with Dr. Colleen McHorney, click
here.
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McKesson Patient Relationship Solutions is a unique division of McKesson Corporation created specifically to help pharmaceutical manufacturers build and expand their relationships with patients. Our core competency is delivering market leading acquisition and adherence solutions such as co-pay discounts, free trial offers, behavioral coaching, contact center services and pharmacy outreach.
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