Maintaining long term persistence
"Bridges conflicting incentives for the various stakeholders"
Everyone involved in a patient’s care, including the patient, loses when the patient discontinues a crucial prescription medicine early, instead of continuing with the medicine for the intended period of time, which if often meant to be lifelong. The patient who stops taking the medicine is deprived of its therapeutic benefits. The 3rd party payor may save some money on drug costs, but incurs whatever added costs arise from the absence of the drug’s therapeutic effects, plus costs that may arise if the discontinuation escapes clinical recognition.
Clinically unrecognized early discontinuation may trigger the prescriber to embark on a series of diagnostic and therapeutic maneuvers motivated by what appears to be the patient’s “drug-refractory” state: special tests and/or the prescription of additional medicines. Nurses who try to ascertain reliable information from the patient about his/her use of the prescribed medicine struggle in a fog created by the patient’s faulty recall and sometimes unwillingness to be candid about his/her use of the medicine in question.
The pharmacist and drug manufacturer loses the revenue stream that ongoing use of the originally prescribed medicine would have created had the patient not discontinued the medicine. Moreover, the drug manufacturer’s marketing program, must find new patients, not only enough to replace those who have started and then, after a few weeks or months, have stopped taking the medicine, but also additional patients to generate a growing number of patients who are, at any one moment, taking the medicine and thereby generating revenues. This constant turnover and replacement of patients, which can exceed 50% per year, is called ‘churn’ in marketing circles, and is, obviously, a costly process. Prolongation of patient persistence with the medicine in question reduces ‘churn’ and thus marketing costs.
A highly effective persistence-enhancement medAmigo program has the potential to increase revenues by 2-3 fold, or more, depending on the initial level of persistence in the marketplace in question. This huge economic potential of an effective persistence-enhancement program is referred to as the ‘unlocking of hidden blockbusters’.
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A medAmigo program dispels the fog that frequently obscures each patient’s use of the medicine in question. It does so because the patient receives the prescribed drug in the MEMS® monitor. The scientific and practical validity of MEMS monitoring has been established by its use in studies from many countries in many clinical conditions, reported in 400 peer-reviewed publications in the clinical research literature. This published record of successful use began in 1989 with a paper in JAMA published by Yale University epilepsy researchers, and continues to the present time, with new studies appearing each month, and with many additional studies in the research ‘pipeline’. Each of these publications represent work done by researchers whose only contact with AARDEX or its predecessor company was to purchase MEMS monitors for studies of their own design, executed in their own way, and written up according to their respective standards. No other technique for measuring patient compliance has even a small fraction of the breadth and depth of this validation, which, because of the long times required for completion of clinical research, has been many years in the making.
A large fraction of the published studies are simply descriptive of compliance patterns in various fields, leaving no doubt about the pervasiveness of omitted doses, while the patient is still engaged with the prescribed dosing regimen, and early discontinuation of dosing. The field has, however, begun to move from description towards efforts to extend persistence and improve patients’ execution of prescribed drug dosing regimens. Five published studies attest to the ability of ‘measurement-guided medication management’ to lengthen persistence and improve the quality of execution of the prescribed dosing regimen. The cornerstone of these 5 studies is a reliable dosing history, which dispels the fog about how well or poorly the patient has executed the prescribed dosing regimen, and allows the caregiver to show the patient what kinds of errors he/she has been making and when they have occurred, e.g., more errors with PM than with AM dosing, more errors with weekend than weekday dosing.
That maneuver sets the stage for review of the patient’s dosing history at the following visit, to see how well or poorly the patient has managed to act on the information previously reviewed. Improving day to day execution of the dosing regimen involves one set of approaches; extending persistence involves another set of approaches. The informed caregiver will use whichever approaches are apt for the patient’s present situation. The bottom-line, in any case, is documented, visit-to-visit improvement in the quality of regimen execution, and maintained engagement with the dosing regimen. Measurement, showing the time-history of dosing, is the cornerstone of successful improvement in the execution of, and persistence with, medically crucial drug dosing regimens.
