We know that many patients never fill the prescriptions given to them by their physician, and fewer still are fully compliant. But what patient beliefs are major factors in adherence with drug therapy?

Kathleen Mazor, Susan Billings-Gagliardi, and Melissa Fischer tackled this question in the recent Journal of Communication in Healthcare article “Initial Acceptance of Treatment with Antihypertensive Medication; the Importance of Communication, Trust, and Beliefs.”

Although it seems obvious, it’s important to remember that for drug therapy to actually occur, a patient must accept the recommendation to start the medication.

The major finding in the study was that there are four major beliefs that impact acceptance of drug treatment:

1) trust in the physician

2) the perception that the physician communicated well

3) the belief that medication is effective

4) the belief that doctors don’t prescribe unsafe medications

Mazor’s study is not without its flaws. Data was gathered by random subjects looking at paper material, rather than an analysis of actual patient opinions of their physician and actual behavior regarding treatment initiation. Mazor herself addresses these limitations, stating that, “While it may be a shortcoming, this methodology is an efficient way to systematically test hypotheses about factors that may influence patients’ decision-making about medications.”

As I dove deeper into this issue I stumbled upon the Trust in Physician Scale which is an 11 item instrument that seems to have decent validity. I’ll have to dig deeper but to see if others have already done the studies linking trust to other “empowered patient” issues. One of the demographic factors this scale uncovered is that people over 55 are far more likely to trust their doctor than those who are younger. As the younger, more empowered (and perhaps more cynical) generation matures, the trust and therefore adherence issue will just become worst.

[What are the drivers of TRUST?]

This leads to the real issue I think which is, How can trust be increased? What are the drivers of trust?

And while physicians and other healthcare providers should certainly be interested in this question, the providers of the medication certainly have a stake in the game too. Perhaps pharma reps shouldn’t just detail physicians on the science of the medicine, but offer suggestions on how best to communicate value to appropriate patients?

What are your thoughts on increasing patients’ trust in their physicians?

Imagine for a moment that you’re one of the 87% of Americans 65 years or older who rely on one or more prescription drugs for your health. Now imagine you’re one of the millions of those patients who, for whatever reason, have difficulty remembering and maintaining those regimens. For older Americans and even younger adults, keeping up with prescriptions can be difficult, but absolutely crucial. It’s trite but true-medication you don’t take, can’t work.

The above scenario is more common than you might think. Almost 60% with prescribed medication regimens fail to adhere to them, with more than half of that group falling behind in the first twelve months, with these numbers increasing in older age groups. It’s a serious issue, too. Around 125,000 deaths a year and 25% of all hospital and nursing home admissions are the result of patients straying from a medication schedule.

FreeRxReminder is an online and mobile service that looks to leverage the cultural ubiquity of cell-phone messaging as a way to deliver regular medication reminders to patients. “The strategy is to help those that have to take medication on a daily basis get easy reminders via mobile and email. It is an easy way to help those that may forget,” says Rex Bowden, CEO of Group Net, the company behind FreeRxReminder.

Group Net is based out of Baton Rouge and is responsible for several other pharma services, including providing subscription vouchers and discount prescription cards to customers. Currently the group does not turn a profit from FreeRxReminder, but is looking for opportunities to monetize.

The site allows users to enter each of their prescriptions, along with dosage information and a specified time for each. The user then chooses between e-mail reminders, SMS reminders, or a printable medication schedule. Each drug is accompanied with a brief description, handy for patients with many different regimens and occasional confusion about what exactly does what.

However, while the company’s press release stresses that the ubiquity of cell phones (citing 90% of Americans as owning and regularly using a mobile phone) makes them a logical platform for medication reminders, the technology involved may in fact turn out to be a hurdle for those who could use this service the most.

Bowden states that the average demographic for FreeRxReminder is women of around 45, but as stated above, senior citizens are the group taking the most medication and having the most difficulty remembering them. Will senior citizens, only 65% of whom even have cell phones, be open to taking advantage of e-mail and SMS reminders? “Yes, there is still a learning curve with text messaging, but this is the largest growing demographic getting the internet and using these ‘new’ services” says Bowden.

FreeRxReminder looks to address a universal flaw on the patient side of healthcare with the aid of technology. Whether or not the aging demographic most dependent on pill regimens decides to embrace this and similar media platforms depends on many factors, including accessibility and evolving cultural views of new information mediums. Bowen’s program, still in beta, is a promising step towards bringing the fruits of the digital age to older consumers.

Courtesy of Bertalan Mesko, MD, Scienceroll.com

In the online world of Second Life, over 12 million subscribers live out an array of fantasies– flying through the sky, exploring alien environments, or strolling through fastidious virtual recreations of cities like Paris or 1920’s Berlin. And the potential of Second Life for medical professionals has been widely accepted; the Imperial College of London’s “Second Health Hospital” enables medical students to diagnose patients and attend lectures all from behind their home monitor.

Looking around the virtual landscape also reveals that patients have been staking claims for years and developing a thriving network of communities. If Second Life’s purpose is to provide a blank slate for players to create their own small utopias, the dozens of support groups, health education communities, and patient havens show that given space and opportunity, e-patients will band together to fill voids in traditional services.

One of the most popular locations in Second Life is “Virtual Ability,” a tropical-themed series of islands geared towards providing disabled players with an inclusive and encouraging community. Other examples include the “Schizophrenia Safe House”, a “place of refuge and support for SL Residents who suffer from schizophrenia…a peer support group without professionals,” the “On With Life” community for stroke victims (a community that is 20 years old but only recently extended to Second Life), and the “Breast Cancer Network for Strength.”

The Second Life directory makes it simple to type in any common disorder and view a list of related locations, groups, and even individuals. A search for Diabetes turns up 12 user groups, a number of active players tagged as diabetic, and three Diabetes-related locations one can instantly teleport to. One, the Diabetes Support Forum UK, had over 150 visitors on one weekday night. Within seconds, a user interested in finding information on or getting in touch with other people with a particular health need can find a wealth of resources, all of it created by users like them, from the ground up.

The professional medical destinations and patient community locations in Second Life show that health education and support can be done effectively in a virtual world. In fact, the cost is relatively modest too. The price of a developable island is about $1,500, with an additional $300 monthly fee, and of course development costs. This is an affordable way to access a channel with 12 million active participants.

For the past five years, obesity has been the number one health risk in America, the root cause of over 400,000 deaths annually and a nearly $123 billion burden on the economy. With 66% of the U.S. population overweight and an astonishing 32% obese, the issue is a constant concern for millions of people seeking to either prevent or eliminate their own weight issues.

Ethicon Endo-Surgery’s “Realize” adjustable gastric band, is a weight-loss device that is surgically placed around the stomach to limit food intake. Realize marketers have turned to YouTube as one of its primary marketing tools.

Featuring tutorials, customer testimonials and expert views, Realize’s YouTube Channel has received over 32,000 views since it’s inception late this June. The channel’s video tags feature a canny mix of specific and general terms, including “lose weight,” “bariatric surgery” and even rival product “lapband” promoting a diverse and broad flow of traffic.

This YouTube push, conceived without a specific ROI in mind, is just one of several online and social media publicity campaigns for the surgery, which is increasingly being touted as not only a way to combat obesity, but some forms of diabetes as well. There is a Facebook fan club with around 400 members and an online support group for customers that deliver recipes, fitness plans, and an opportunity to communicate with other members.

[...Realize's YouTube Channel has received over 32,000 views since it's inception late this June.]

However, on YouTube, Ethicon has turned off its social media features. The videos on their channel do not allow ratings or comments, nor does their Facebook page, hobbling the entire “social” aspect of social media and possibly raising skeptical eyebrows among casual browsers.

Furthermore, while a Discovery Health documentary hosted on the channel does feature information from real surgeons and other doctors, this content isn’t featured prominently. The channel’s “From the Experts” section only has testimony from a psychologist, a dietician, and an insurance expert-hardly the expertise most patients are likely to look to first. Previous research from Kru and others has shown that trust is a key variable to a health consumer actually taking action or talking to their own physician, and an onscreen real doctor would actually move Ethicon a lot closer to their goals.

YouTube videos garner massive viewership and the site has emerged as one of the most popular search engines on the Internet. Ethicon Endo-Surgery is wise to have launched this channel and the video on it are well produced. A person considering a gastric band certainly does want to hear from others who have gone through the procedure, so the prominent display of patient testimonials was also smart.

However, physicians continue to be a trusted advisor on health issues and those videos should be increased in terms of quantity and prominence. Lastly, Ethicon would be wise to enable the social features on their social platforms. Although fearful of negative comments, pharma will soon realize that negative comments only increases the credibility of the content in the eyes of the potential customers.

This is pretty cool and fun to watch. It’s a video recording of an H1N1 seminar Dr. Jay Bernhardt and others did on Second Life.