Not loading?

Human-centered Patient Care

Today's spotlight is on patient adherence, a factor that is fundamentally changing the way we interact with medicine, care givers and health services.

What do we actually mean by ‘patient adherence’ and what impact is it having on us? 

Adherence describes someone’s willingness to stick to, or be faithful to something. In the medical services industry, adherence assumes that patients understand and agree with a recommended prescription or regime – empowering them with a dosing schedule and allowing them to take treatment into their own hands. Adherence is often used interchangeably with the word compliance, which implies patient passivity in correctly following instruction and medical advice given by the paternalistic role of the physician. 

Patient adherence and their consequential level of compliance are important aspects of whether a treatment outcome is successful or not.

Established problems with true adherence can tremendously impact the patient's quality of life, as well as healthcare providers and the economies gravitating around them. 

The World Health Organization (WHO) states that ‘increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments’

This is especially evident when treating asthma and chronic obstructive pulmonary diseases (COPD), for example, which affects about 500 million people worldwide. Goldman Sachs analysts estimated in a report last year that ‘... the opportunity of reducing serious attacks by improving adherence could save $19 billion a year of U.S. healthcare costs alone’.

Although adherence is definitely critical to the success of prescribed regimes, current lifestyles, habits and behaviours often do not help. The WHO regularly reports that average adherence rates in developed countries are below 50%, resulting in sub-optimal disease control, despite the availability of effective medical treatments. The complexity of today’s healthcare makes it unlikely for many of us to fully understand medication dynamics and therefore to be competent in self-care therapies; yet physicians struggle to successfully compel adherence and patient cooperation, as the historic Hippocratic Oath asks. 

Fast innovating Pharmaceutical companies are no longer underestimating this phenomenon and they are beginning to actively promote adherence through new multifactorial strategies and sophisticated products.

Over the last decade the pharmaceutical sector has witnessed the rise of technological means to monitor, guide and evaluate patient adherence: smart e-devices, nanotechnology, wearable sensors, avant-garde robotics, connected & mobile Apps, ad hoc medical platforms, data gathering systems, etc. Humanity is not as sceptic, nor resistant as it used to be; the potential benefits and advantages are breaking down previous perceptions and barriers. We are genuinely embracing technology into our routines, letting it work with us, around us and for us.

Electronic medical devices are already capable of accurately assessing individual competence and accommodate accordingly, reporting on user behaviours, guiding them along medication regimens and ultimately enhancing coordination of care and its efficacy. 
Without interfering with drug chemistry, these new generations of devices offer multiple and interesting advantages:

These novel smart devices are now considered the market’s ‘gold standard’ in terms of adherence, providing a reliable alternative to patient’s subjective monitoring. 

However, 'smart' products do not necessarily have to imply embedded electronics to be considered as such. Effective human-centric design can promote adherence and prevent misuse in many other creative and efficient ways... 

What about a future where people on medications do not need reminders or training any more? 

Emerging technologies have reached an exciting stage where the application of future medical care is no longer restricted by traditional environments, beliefs and behaviours.

Common medicines could be delivered via foodstuff, while smart cutlery could keep track of the quality and quantity of meals, providing live feedback for diabetics’ insulin control or on potential allergens. Asthma preventive nano-medications could be embedded into a person's bedding and slowly released while sleeping. These same drugs could be applied to the mouth via make-up, being absorbed during the course of the day, or via toothbrushes for a twice daily dose. Smart garments could automatically react to environmental conditions and household items, such as flooring tiles and carpets, could track our body chemistry, overall statistics and postural behaviour. 

It is plausible that rapidly evolving drug-delivery technologies are likely to offer great hope and diversify the range of tools available to clinicians, researchers and patients, offering a better understanding of the types, causes, consequences and potential solutions of poor adherence. 

Successful intervention on patient education (the common route of the problem), adherence and the consequent compliance remain an ambitious task. The Crux team are constantly challenging preconceptions and barriers from different perspectives. Whether this is re-engineering the mechanical functionality of a device to simplify its usability, integrating smart tech into products to improve the experience they offer or designing new innovative means to facilitate how people can self-manage their own wellbeing in the most effective way.

Andrea Ceccaroni