Patient Support Programs (PSP’s) are playing an increasingly important role in managing and improving patient outcomes. While solutions range from providing patients with access to therapy, adherence support, patient education and training, amongst others – many of them fall flat without patient engagement. This is why technology, paired with behavioral science, becomes a unique platform and an opportunity to provide impactful patient support. Applying behavioral science into digital program design allows programs to target behavior change… and patient behavior is key for achieving optimal patient outcomes.
We found that applying behavioral science to our patient support programs have allowed us to have a much greater impact on three key areas critical to improving patient health outcomes: adherence to medication, adherence to lab monitoring and adherence to clinical appointments.
Patient non-adherence to medication is a major healthcare challenge. According to the WHO, only about 50% of patients in developed countries adhere to their medication after one year of the treatment. Non-adherence is even greater amongst patients on long-term therapies for chronic conditions.
Why does non-adherence to medications matter? Poor medication adherence has been found to be linked to successive hospitalizations, disease progression, comorbidities, additional medical interventions and even death. Additionally, the cost of non-adherence adds up across the healthcare system. In the U.S. alone, it is often estimated that the cost of medication non-adherence is $250 billion per year.
There are a variety of reasons why patients do not take their medications – ranging from drug cost to social health determinants (such as transportation). However, according to the American Medical Association, most non-adherence is intentional. Commonly cited reasons include fear, worry, misunderstanding or a lack of symptoms, all of which are conscious decisions to abstain from their treatment.
Understanding these challenges reveals an opportunity to build trust with patients and guide patients to adhere to their treatment regimens based on their motivations or needs. Digital health tools have demonstrated to be effective tools to impact health behavior change. For example, research finds that, in general, mobile phone messaging almost doubles the odds of patients remaining adherent to treatment. Another study found that smartphone app notifications produce similar results to text messages, successfully improving medication adherence in a randomized control trial of patients. Research has also found that patients may be more honest with an app than in a personal conversation with their doctor.
Engaging patients on a deep and personal level has been incredibly successful. We’ve found personalizing messages to patients regarding their treatment adherence, as well as notifying them if they’ve missed their medication has been incredibly effective in improving behavior to further nudge their behavior in the right direction. We have also found that intrinsic motivations – such as goal setting – are more beneficial to patients than extrinsic motivations (such as gamifying the user experience) to help patients feel like they’re achieving a milestone. Importantly, patients feel less like an anonymous participant and more like an empowered individual who understands their treatment and whose healthcare team is looking out for them.
Lab Monitoring Adherence
Adherence to medical recommendations can be critical for patients on complex therapies. Some complex therapies require regular laboratory testing or imaging studies to ensure the safe use of that medicine.
Subtle behavioral science tactics nudging both patients and providers with lab monitoring result in improving lab monitoring adherence. For example, we have programs that target patients with direct lab monitoring reminders and providers, with visibility and notifications of patients’ lab monitoring adherence. The result has been a more engaged and compliant patient population- with adherence rates with patients on the program over 5% higher than patients that weren’t on the program.
Clinical Appointment Adherence
The patient missed appointments create inefficiency in the healthcare system and can lead to delayed diagnoses and treatments for patients. Forgetfulness is a leading cause for the missed appointments and simple reminders about upcoming appointments can reduce this problem and missed appointments.
A tactic that has been found to be effective in keeping appointments is using mobile phone texts or calls to remind patients about upcoming appointments. Research has found that overall “the attendance to appointment rates were 67.8% for the no reminders group, 78.6% for the mobile phone messaging reminders group and 80.3% for the phone call reminders group”.
Of course, different patients respond to different cues. While research results vary based on the condition, one study found that while mobile health tools are largely beneficial, minorities, older adults and those with lower health literacy were less engaged in mobile health tactics. For this population, a phone call may be more effective to remind them of an upcoming appointment.
We have found that simple reminders have had a significant impact on improving patient clinical appointment adherence, with the greatest success when patient care providers were included as part of the patient’s care team.
Leveraging behavioral science with technology can create a powerful tool/solution to address non-adherence, and as a result, patient health outcomes. As health applications become increasingly available, they allow us to engage directly with patients, providers and the patient’s care network that can impact patient behavior. This creates an opportunity to provide targeted interventions to address behaviors leading to non-adherence. Issues such as medication and appointment non-adherence can all be improved with technology-based behavioral health tools.
Looking ahead, behavioral science isn’t a trend, but a growing movement that’s here to stay. You can find successful companies such as Noom and Livongo built on the fundamentals of behavioral science and revolutionizing health habits. Respected universities are opening entire schools dedicated to studying it. Expect to see the use of behavioral science accelerate in the coming years as more companies are inspired by its success stories and lean into its teachings.