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Nonadherence to treatment: the use of behavioral science for better outcomes


Nonadherence to treatment results in higher mortality and healthcare costs that could be preventable when patients are better informed and obtain effective support in their treatment. The last few decades there has been an increase in scientific research that aims to facilitate behavioral change to encourage and promote healthy behaviors, using important and relevant insights from behavioral science. Nonetheless, currently, we still do not fully understand all the factors that influence the decisions patients make when it comes to their treatment and why they are sometimes non adherent to a treatment that they have accepted after receiving their diagnosis. With the healthcare industry shifting to value-based and outcome-based payment models worldwide, patient outcomes are increasingly important for securing favorable medication and treatment reimbursements, and more importantly, to improve healthcare provision and health related outcomes of European citizens.


At PredictBy we are identifying and mapping several behavioral and psychological drivers that are associated with nonadherence to treatment in order to identify key factors where behavioral science insights could be considered in order to make a strong and lasting impact to improve patient adhe- rence to treatment.


Behavioral science explains how people are predictably irrational, and it can also reveal how to utilize decision errors in order to help patients to make better decisions and improve their quality of life and health related outcomes. More specific, a significant behavioral driver attributed to nonadherence to treatment is present bias, which is the tendency for people to discount larger future rewards and prefer smaller immediate rewards. For example, present bias causes patients to discount future payoffs which makes it hard to motivate themselves for behavioral change when rewards are more distant in the future, especially when the change requires constant work and health related behavior that is not necessarily directly rewarding, such as eating more healthier or exercising. Because of hyperbolic discounting, adhering to medication or lifestyle changes in the future may be seen as having more value than adhering today, which leads to an endless cycle of procrastination and nonadherent behavior.


One example is that nonadherence is increased for patients having chronic disease states, such as cardiovascular disease, where missing a day of medication or treatment does not result in any immediate negative consequences. If there are no painful symptoms that the medication addresses, then there is no immediate reward (such as a reduction of pain) associated with taking the medication or following any kind of treatment. The immediacy and saliency of feedback is essential to encourage a behavior, which is lacking for this type of medication and disease state, leading to nonadherence behavior and a deteriorated health state.


IN GENERAL, USING BEHAVIORAL SCIENCE TO CREATE AN IMPACTFUL INTERVENTION FOR BEHAVIOR CHANGE IS A LESS EXPENSIVE AND MORE EFFICIENT METHOD THAN INVESTING RESOURCES IN THE DEVELOPMENT OF NEW TREATMENTS.


As a result of our work, we will be able to provide a low-cost framework for incorporating behavioral science into adherence to treatments to increase efficacy in behavior change and ultimately improve individual quality of life and lower overall societal healthcare costs. With increased investments in digital health across the European Union, and adherence to treatment as a key market opportunity for businesses and healthcare providers, incorporating behavioral science for improving patient adherence can have a significant impact on behavior change.

 

References:


Hugtenburg, J. G., Timmers, L., Elders, P. J., Vervloet, M., & van Dijk, L. (2013). Definitions, variants, and causes of nonadherence with medication: a challenge for tailored interventions. Patient preference and adherence, 7, 675.


Gast, A., & Mathes, T. (2019). Medication adherence influencing factors—an (updated) overview of systematic reviews. Systematic reviews, 8(1), 1-17.


Putera, I. (2017). Redefining health: implication for value-based healthcare reform. Cureus, 9(3).



 

Written by: Frans Folkvord

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