How changing emphasis can be a game changer

The financial implications of COVID-19 will  

be felt for generations to come. As economies emerge, governments will be looking at ways  to cut spending and reduce costs. In healthcare they will be looking at contracts with providers and, on a more granular but no less financially significant level, at reducing waste by improving factors such medicines concordance. 

Concordance is a hotly debated topic in name as much as anything else.  Of the three terms that have been used to describe how patients stick to taking their medication; adherence, compliance 

and concordance, the latter seems most apt in an era of shared decision making. 

Whichever term is used, poor concordance costs millions each year. According to 2019 figures from NHS England, an estimated 50% of patients do not take their medicines as prescribed. Around one-third of patients take medication to the degree it is effective; one-third follow advice but not enough for the medication to make an impact; and the remaining third simply do not follow advice.

From an economic and political standpoint, the message around less waste of prescription products and increased use of diagnostics will be dialled up in the months and years to come. It is likely that under increased economic pressure, governments will demand that industry is more accountable and responsible for patient concordance; increasing the support framework and services around products.

While ultimately the responsibility for concordance would continue to lay with HCPs and patients, regulators and clinical recommendation bodies are likely to request that industry develops tools and support structures to help HCPs better communicate the benefits of medications/interventions to patients, giving them the tools they need to improve concordance. 

Could this result in increased scrutiny  from regulators? Will they demand that new criteria are met resulting in industry taking responsibility for not just the efficacy of products, but also how they are taken by patients in a way it has never needed to before? 

Is this the incentive the industry needs to ensure it switches emphasis from product features to benefits and to developing services in support of this? Not only does concordance improve patient experience, it also improves HCPs’ perception of a product. 

This is a revolution 

Although challenging, this presents the industry with a great opportunity to be at the forefront of not just developing drugs, but supporting appropriate prescribing and improving concordance to save lives; reducing waste  and saving money across health systems. 

The challenge will be uncomfortable and counter-intuitive for many because this isn’t about products, this is about how human beings engage with their health. It is about how appropriate prescribing and concordant use of any medication or intervention will improve outcomes – from taking antibiotics to 

checking blood sugar levels.

It is about winning share-of-mind among HCPs and catalysing behaviour change in patients. It’s about enabling HCPs to cast off entrenched behaviours – those learned while training and those absorbed from working with more senior colleagues – through development and use of materials that level the communication playing field, moving from an authoritarian HCP–patient dynamic to a cooperative and deliberative relationship anchored in active listening.

Through better support for HCPs, industry could be instrumental in helping change patient behaviours through greater understanding of the importance of taking medication correctly and provision of more tools to help them manage their medicines. 

The focus needs to shift from talking about the product and the environment, which in recent years has been characterised by terms such as self-care and shared care, to thinking in far greater depth about the implications for the patient; the quirky human being at the centre of it all.

The time is now

Collaboration among all stakeholders is crucial to overcoming the numerous hurdles evolved in winning share-of-mind and changing behaviours.

The aftershocks of COVID-19 will be numerous and significant but the crisis offers the opportunity to change the way we interact;  to ask questions we lacked the confidence  to do so before. What we thought we knew about almost everything, including our own sense of self, has changed. The HCP who we thought would never embrace remote engagement can now see the benefits, while the patient we never imagined would take advice about their health is changed on seeing, daily, how vulnerable we humans are.

To ensure it stays relevant, industry must adapt its thinking and explore ways it can  be ethically involved in providing solutions to poor concordance.

This represents a new way of operating; there will be innovators and early adopters, as well as laggards. The latter are likely never to alter their behaviours, but that’s not a reason to hold back on helping those who want to change to do so.