1. 1 IMPACT of EMOTIONS on ADHERENCE 2. 2 Introduction s The Adherence Issue Implications Case Study 3. 3 Who We Are eCollageTM Scene Builder Concept Focus Thought Bubble I wish I could Hive Who We Are 4. 4 The Nonadherenc e Issue What It Is Prescription not filled Taking incorrect dose Taking at wrong time Medication not taken correctly or not taken at all. Evidenced by: Skipping doses Stopping too soon 5. 5 Nonadherenc e by Category 0% 10% 20% 30% 40% 50% 60% 70% Genitourinary system Infectious and Skin disease Pain (primarily) Musculoskeletal Respiratory system Mental and behavioral Digestive system Endocrine and Circulatory system Headache (primarily) 0% 10% 20% 30% 40% 50% 60% 70% Hypertension Hyperthyroidism T2D Seizure disorders Cholesterol Osteoporosis Gout Unfilled Prescriptions, by Therapeutic Category Nonadherence (below 80% compliance) 6. 6 Nonadherenc e Cause/Effect Results Hospital/ER Back to MD More medication Urgent care LTC Drop out Death WHY? Huh? Trust Oops Poison 7. 7 Hospitals, $937 Doctors, $587 Rx Drugs, $271 Long-term care, $156 Therapeutic services, $308 Dental, $111 Medical equipment, $99 The Costs of Nonadherenc e National Healthcare Spend 2013 Doctors 8% Hospitals 64% ED Visits 7% Long-term Care 19% Rx Drugs 2% Cost of Nonadherence by Category Total US Health spend: $2.7 Trillion Total Cost of Nonadherence: $310 Billion (11%) 8. 8 Behavioral Educational Affective Provider Four Types of Programs to Boost Adherence Providing supportive context for patients 9. 9 What does food experience mean to millennials? About the Approach About the Study Results of the Study What we Learned 10. 10 No imagery The Role of Imagery 80% With imagery 11. 11 Visual Communicatio n and Adherence 12. 12 Results of the Study About the Study Results of the Study What we Learned 13. 13 Adherence Case Study Research Objectives HOW WE APPROACHED IT ENABLING TECHNIQUES PROJECTIVE TECHNIQUES IMAGERY & ASSOCIATIONS ATTITUDES & BEHAVIOR 1.Assess rational factors driving non- adherence 3.Understand disconnect between rational and non-rational. 2. How can visual & latent emotional insights improve adherence? 14. 14 What Causes Nonadherenc e? 14% 85% 2% Yes No Not sure 25% 75% 0% Yes No Not sure 33% 36% 32% Yes No Not sure = statistically higher I felt good Wanted to avoid side effects Felt depressed/overwhelmed Had a change in my daily routine Simply forgot Was away from home Was busy with other things Just didnt want to take it Feel like the drug is toxic/harmful Feel angry about having to take it I missed taking my medication in the past month because Forget to fill the prescription? Decided not to fill the prescription? Possible to manage without meds? TopTier SecondTier 15. 15 How eCollageTM Works http://www.buzzback.com/tools/#ecollage What thoughts, emotions, & images come to mind when you think about how you are managing your condition? 16. 16 Diverse Image Library 17. 17 Emotional Dimensio ns of Condition s Optimistic & Confident Highs & Lows Struggle & Despair 18. 18 HOPE I understand how bad it can be and am doing what I can to keep under control Male, 66, Type 2 Diabetes Emotional Dimensio ns of Condition s 19. 19 Optimisti c & Confiden t What they tell us Balance Maintenance Being proactive Common sense Partnership with doctor Dont let disease define you Self-love = self-care Watch weight. Preventive maintenance. Balanced diet and lifestyle. Be smart using salt and sugar. See MD regularly. Add together = success. Male, 66, Type 2 Diabetes 20. 20 Highs & Lows What they tell us Condition is a puzzle, but pieces can fit What you want is not what you need We all have ups & downs Managing is an effort that might fail Still, maintaining hope for a solution The two in the upper left are for diet and exercise, which are my main tools for managing my diabetes. In the upper right is my doctor. Below that is the tightrope it sometimes feels like, juggling what I'd like to do or eat vs. what I need to do or eat. At the bottom is the excess weight I've shed, and the excess weight I'd still like to shed. Male, 64, Type 2 Diabetes 21. 21 Struggle & Despair Uncertainty and frustration Results? Does my doctor know what shes doing? Trapped in a treatment cycle Always seeking answers Stress of trying keeps me from success Blame and shame Always flirting with disaster Will this kill me? What they tell us The first row is indicative of the stress and battle of fighting the condition the monitoring and the ups and downs. It is not an easy process. The second row captures the many questions one has about the condition, its causes, what to do about it. This uncertainty isn't helped by a growing bombardment from pharmaceutical companies to other health related companiesThe last row underscores the importance of medical advice and support Male, 45, Type 2 Diabetes 22. 22 What Could Be Done To Help Manage Condition ? Patients want to believe in lifestyle choices Medication is there, but among many others 23. 23 How Patients Feel After Medication? Relaxed / making progress Calm and safe Need to keep going Keep it up It looks like he is ready for the day; anxious to get going; enjoy life. I rarely feel down or confused after I take my meds. Happy, in control Relaxed, but cautious Tired, frustrated I get frustrated because I feel that I put myself in this position in the first place. I feel run down, because nothing I do seems to control it. Happy Ready to get on with day Jumping with joy energized Feel like I am doing right thing I feel relaxed and comfortable that I am taking care of myself but I also know I need to keep up with it and make sure all is fine. Feel like I am falling Frustrated Tired / no energy / stressed 24. 24 Projective Technique s Please type your answer into the imagine bubble and click Continue when youre done. Imagine a conversation with your doctor when you tell him or her that you havent been very good at keeping up with your treatment. What do you say and what does your doctor say? I have fallen off my treatment plan, things have been hectic at work, the dog has been sick, my son started college so I have been under too much stress. 25. 25 I would say that taking these medications every day makes me feel like I am dependent on chemicals to live Dr. says: you should take my advice seriously. I say I do, but my increased exercise helps me manage better. Disbelief or aversion to evidence-based medicine Relationshi p with Meds and with Doctor I have been trying to keep up with my diabetes but it is hard. I have had to totally change my diet and had to fit a lot of exercise into my already too busy schedule. "Well, not everything in life is easy. The changes you have made may be hard, but they are important to manage your condition and health. Candidly, these MDs would just say, well you need to work on that and don't do it again - no matter what you tell them. There's not a lot of humanity in their human contact. Lack of sympathy towards the Patients struggle Some antagonism between patient and doctor 26. 26 What We Learned About the Approach Results of the Study What we Learned 27. 27 Causes of nonadherence are multi-faceted & complex 75% patients dont actively decide not to fill prescription 65% arent convinced medications are necessary Many just need more information Patient physician relationships have strong impacts on adherence Better physician relationships seem to lead to better adherence Patients need stronger partnership and support with physicians on how to change lifestyle successfully They want to see data to support why they need to take these medications and the long term benefits Summary: What We Learned 28. 28 Summary: What We Learned Ongoing struggle with responsibility for taking medications Feeling dependent on needing this for life Concern over long term adverse events The two in the upper left are for diet and exercise, which are my main tools for managing. In the upper right is my doctor. Below that is the tightrope it sometimes feels like, juggling what I'd like to do or eat vs. what I need to do or eat. At the bottom is the excess weight I've shed, and the excess weight I'd still like to shed. Male, 64, Type 2 Diabetes Emotional experiences around adherence are challenging 29. 29 Any Questions? To learn more, contact John Mitchell: jmitchell@buzzback.com @johnbmitchell Connect with us online Additional studies Patient & Physician Perspectives on Diabetes Patient & Physician Perspectives on COPD Exploring Healthy Patients & Health Care 30. 30 About BuzzBack At BuzzBack, were committed to pioneering new techniques for online research techniques that provide richer understanding, depth and emotional insights. For more than fourteen years, we have helped major global consumer, pharmaceutical and financial services companies successfully connect to their customers, and optimize hundreds of concepts and new product ideas in over 40 countries. Both our techniques and our researchers have been recognized by the industry for research distinction, with numerous awards from the ARF, MRS/ASC, and ESOMAR. We offer a range of experience and expertise to meet your needs. www.buzzback.com