How many times have you gone to the doctor’s and been irritated by what they told you or how they spoke to you? Maybe you felt like they patronised you and spoke to you as if you were a child. Or maybe they gave you too much detailed information and you couldn’t follow it. Negative interactions like these could discourage people from following their planned treatment.
More than half of all patients don’t take their treatment as planned, which results in one in every ten hospitalisations.
The BEAMER project explored why people don’t always follow treatment plans and found that while some of the factors were immutable, others were behavioural and could be modified.
“We can nudge and provide effective, personalised support to modify patients’ attitude toward their treatment. This, in turns, helps them achieve their treatment goals,” says Fulvio Michelis, strategy director in the digital health unit at Merck and project co-coordinator of BEAMER.
The project is an example of implementation science – the branch of science that helps smooth the way towards the uptake of health innovations in the real world. Investigating the factors that prevent the uptake and use of new health innovations is important – because after all, how can new therapies be successful if patients don’t follow their treatment plan?
The first step taken by BEAMER was to analyse who wasn’t taking their treatment and why. The project successfully divided the patient population into four main groupings, and then devised a strategy for healthcare professionals on how to deal with each group to maximise patient adherence to treatment plans.
Motivated patients
The first group consists of well-informed patients who want to receive detailed information and have an active share in the decisions made regarding treatment. These patients may research their condition and the various treatment options, and will come to the doctor’s office expecting an in-depth, detail-laden discussion. These patients can be alienated and may stop taking their medication properly if they are spoken to like children, or not given enough information, or feel like they are being dictated to rather than being involved in the decision-making process.
Fitting treatment around other life priorities
The second group are people who have a lot going on in their lives and their healthcare just isn’t the most pressing issue.
“Perhaps getting their kids to school is their highest priority, or work commitments, or other aspects of their life. For this group, healthcare is important, they feel they ought to do it, but it’s just not the biggest priority. We need to help them to fit the treatment into their life. One way to do that might be to provide targeted information that helps to raise the importance of healthcare or to provide practical support,” says Michelis.
One example is a person who had to take an injection every two weeks, who could never remember if it was the week for the injection or not.
“She said it was a nightmare, but she found her own solution. She realised the recycling bins were collected once every two weeks, so she took her treatment on that day,” comments Michelis.
Little hacks like this can help the second group of people to stick to their treatment plans better, and reap the rewards.
Overwhelmed and not accepting the need for treatment
The third group identifies people who are overwhelmed by their condition and possibly by other things going on in their life as well. The main difference between the second and the third group is that the second group have accepted that they have a condition and are just juggling too many other priorities, whereas the third group have not accepted their condition.
“There may be too much going on or a limited ability to cope with too many things, but the outcome is the same: they don’t have the time or the energy to think about it, to take it in,” says Michelis.
The solution for this group is simple, clear information – the opposite of what someone from group one would want.
“What they need is just the essentials, and step by step support to be able to do one thing at a time, add it into their routine, and build their confidence that they can do this,” says Michelis.
Maybe the diagnosis is wrong?
The fourth group are those who haven’t yet come to terms with the fact that they are ill.
“If you’ve not yet accepted your condition, then you're not likely to do anything about it,” says Michelis.
This group is similar to group one in that they might be doing a lot of research, but they are looking for evidence that their diagnosis is wrong or that there is a better solution. People in this group may distrust healthcare professionals, and they’re more likely to search for support and information from a peer group.
Highlighting the need for emotional support
The third and fourth group are generally in need of emotional support to accept their condition, Michelis says. However, healthcare professionals or patient support teams don’t often look at things from that angle, and this could be improved.
“We have a tendency to focus on the therapy and assume that the patient is onboard with it. This works well for the first two groups, but it stops people from the third and fourth group from getting the right type of support to help them to take control of their health”, says Michelis.
The B-COMPASS solution
Separating patients into four groups is all well and good, but how can a healthcare professional and patient support teams know into which group a patient falls? Especially when most doctors only have five-ten minutes to spend per patient.
BEAMER developed a questionnaire, B-COMPASS, which consists of just six questions designed to group patients by their needs. The idea is that while in the waiting room for a doctor’s appointment, or before an interview with a patient support team, patients fill out the questionnaire and the result is given to the doctor just before the appointment. The healthcare professional can quickly see which style of information delivery or support would work best for the patient and adapt accordingly. They can provide lots of detail about their condition and the choice of treatment plan, or limit their intervention to simple and clear instructions; they can support patients to build a plan to fit their treatment into their life, or determine whether they need emotional support to come to terms with their condition.
This can help the healthcare professional and patient support teams to deliver the right information in the right way to patient. BEAMER have hypothesised that this will lead to better adherence to treatment.
Pilot studies kick off
To test out this hypothesis, pilot studies for BEAMER are kicking off in 2025. The pilots will take the form of randomised control trials, covering six different conditions across eight countries.
The patients will be divided into two groups; one group will receive the current standard of care and the other group will use the B-COMPASS questionnaire system.
Michelis says that, if B-COMPASS is proven successful, more people could receive the kind of care they really need, and that this can boost health outcomes. He says that a one-size-fits-all approach is outdated, and that personalising treatment can lead to better results for the patient.
“If you provide the same support to everybody, there’s always going to be someone who is not getting the type of support that they need. Understanding these different subgroups means we can ensure better health equity,” he says.
An important consideration, he says, is that people can move from one group to another.
“A person might start off overwhelmed (in the third group), but, by helping them through step by step, they can move to one of the other groupings, to where they feel like they have their condition under control.”
People can switch from one group to another at any time, so for the pilot study, participants must use the BEAMER B-COMPASS questionnaire before every doctor’s appointment to track any changes.
Value-based healthcare as a driver for more adherence solutions
While healthcare systems are aware of the dangers of non-adherence (e.g. complications for patients, higher long-term cost), effective solutions are lacking. With a shift toward value-based, there is a growing interest to increase patient adherence.
“We see that companies are increasingly more interested in developing solutions that, beyond the drug, support the patient during their whole care path. Remote patient monitoring, personalised support, digital biomarkers, and many other technologies are used to know patients better and support them individually,” says Michelis.
“BEAMER aims to build the scientific foundation for future work and future research. Thanks to its disease-agnostic nature, it will equip us with the knowledge and tips on how to best support patients across therapeutic areas. This will guide us to provide the best care and the best solutions to enable patients to thrive,” says Michelis.
BEAMER is supported by the Innovative Medicines Initiative, a partnership between the European Union and the European pharmaceutical industry.