Beyond Compliance, Adherence, & Concordance – Supporting The Patient’s Implementation Of Optimal Treatment

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Patient Segmentation By Medication Compliance Attitudes

February 25th, 2007 at 8:06 am · · AlignMap, Enhancements · No Comments

Source: Getting patients to take their medicine Jessica Hopfield, Robert M. Linden, and Bradley J. Tevelow. McKinsey Quarterly No 4. Dec 14, 2006

Medication Noncompliance

A McKinsey study of hypertensive patients indicates that half of the 65 million people in the United States with high blood pressure don’t adequately follow their drug regimen. Moreover, “the usual interventions—for example, electronic reminders or easy-to-open packaging—tend to improve adherence only in the short term, largely because a one-size-fits-all approach fails to address the underlying causes of the way patients behave.”

A more powerful means of improving treatment adherence and effecting cost savings and better outcomes, according to the study, are compliance improvement programs that recognize and address variations in patients’ attitudes toward compliance with treatment.

Further, as the article notes, Creating and implementing these programs will require the combined efforts of physicians, patients, pharmaceutical companies, payers, and other health care stakeholders.

The Segmentation Process

810 hypertensive patients were surveyed, interviewed, and assessed via focus groups in exploring five themes:

  1. The patients’ level of involvement and perceived control over their health
  2. The patients’ knowledge of hypertension and its treatment
  3. The patients’ level of concern about the disease
  4. The patients’ beliefs about the safety and efficacy of medications
  5. The quality of their interactions with physicians

A statistical analysis of the relationships between the attitudes and self-reported behaviors of patients, described six population segments, ranging from proactive patients, who scored high on all five themes to skeptical patients, who,deeply distrusted both physicians and medications and almost never complied with their treatment regime. Between these extremes are confident patients, concerned patients, confused patients, and resigned patients.

Using Segmentation Strategies

While similar segmentation approaches have been used effectively in marketing (including anti-smoking campaigns), this tactic has not yet been widely used to improve the adherence of patients to their treatment regimen. The authors suggest that it should, arguing that “different types of patients have very different reasons for not taking medication.”

They found, for example, concerned patients might respond well to information on their medication’s safety while the compliance of confident patients might be most affected by programs that reward consistent, long-term usage.

The article points out that more work is required to devise compliance-enhancing interventions that correlate with the different patient segments.

The descriptions of the patient groupings, the five themes investigated, and the possible correlations between patient segments and compliance enhancements are elaborated in more detail in the article, which can be found at
~Getting patients to take their medicine~


Alignment Of Healthcare Stakeholders
A secondary but nonetheless significant point in this context is the afore quoted line from the article, Creating and implementing these programs will require the combined efforts of physicians, patients, pharmaceutical companies, payers, and other health care stakeholders, which I contend deserves more emphasis and explanation than it was given in the article. It is, one supposes, possible that this criticism has something to do with the fact that this sentence is virtually identical to the primary premise of AlignMap.

Patient Segmentation
Segmenting patients according to their attitudes pertinent to medication compliance is not a new concept. The scheme outlined in this article, in fact, is similar to one that colleagues and I devised over five years ago,1 and other segmentation-based programs have been instituted on a limited basis.

The problem has been and continues to be the lack of openly available, non-proprietary evidence indicating the effectiveness of programs using this approach.2 As we and others have discovered, clinical tests of this concept that are of sufficient scale and power to produce valid, reliable results are dauntingly complex and difficult to design as well as formidable and expensive to execute.

The process described in the McKinsey article is alluring, as are similar concepts, including our own, but it and its analogues remain untested and unproven.

The Potential Payoff Of Patient Segmentation
If, however, the effectiveness of compliance-enhancement programs tailored to particular patient segments can be successfully demonstrated, they would offer a solution for the conundrum described in the previous post, Health Literacy: A Clear Problem Without A Clear Solution, i.e.,

How can healthcare information be efficaciously communicated to patients who are unable to take on the proactive, self-advocating role of the “expert patient?”

Such a breakthrough would have the potential to create a quantum leap improvement in outcomes and reductions of healthcare costs, dramatically transforming healthcare in the process.

That seems worth pursuing.


  1. We ceased work on this project because we couldn’t directly validate it with clinical testing (a small scale effort did provide results that were encouraging but fell short of convincingly confirmatory). We finally ran out of money and time to donate to the cause and we weren’t clever enough to try publishing our system without proof.
  2. Some segmentation programs claim research-proven effectiveness but refuse to disclose that research or to make it available for others to attempt duplicating the results because the programs and the research are proprietary. My arguments that the support of the medical community and the publicity that would result from openly available research that was proven accurate and duplicable would outweigh the proprietary risks have not been persuasive in lifting the veil obscuring these secrets, even on the most limited basis – e.g., signing nondisclosure agreements.

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