Support healthcare system resilience through a focus on persistency in the treatment of chronic diseases

Expected Impact:

The action under this topic is expected to achieve the following impacts and contribute to the following EU policies/initiatives:

• improving outcomes for patients with chronic diseases by supporting them to stay on the recommended and most efficient treatment, reducing symptoms and side-effects in the best way;
• less co-morbidities for patients on chronic disease treatment;
• reducing inefficiencies and costs in healthcare systems.

These impacts are in alignment with objective 2 and 3 in the IHI JU.

Results from the IMI BEAMER project are expected to be taken into account and incorporated. The action resulting from this topic is expected to reach out and work together with other initiatives, e.g. IMI Gravitate Health and those funded through the Horizon Health call on “Ensuring access to innovative, sustainable and high-quality health care”. Data collection will be in agreement with recommendations from the European Health Data Space (EHDS).

Expected Outcome:

The main outcome of this research collaboration is to better understand why significant advances in technology in recent years have not contributed to widespread improvements in healthcare systems, which still struggle to keep more than 50 % of people on chronic disease treatment for longer than 12 months. The goal is to develop and pilot innovative and multi-stakeholder approaches leveraging social innovation activities and scalable technology to improve the health outcomes of people living with chronic diseases by supporting treatment persistency with a particular focus on diabetes, obesity, and cardiovascular disease. Persistency is part of drug adherence and is defined as the length of time between starting treatment and the last dose which immediately precedes discontinuation of medication.

Although novel treatments are becoming more available with major improvements in convenience and efficacy, poor persistency to treatment is still a major challenge in the healthcare system. Insights from pilots under this topic will be shared with relevant stakeholders of the healthcare ecosystem to improve outcomes for people living with chronic diseases. The pilots should include cardiometabolic diseases, such as diabetes, obesity, and cardiovascular disease. Other chronic diseases may be considered in this collaboration if they contribute to the overall understanding of barriers and opportunities. Moreover, it is not the goal to develop new technologies and/or pharmaceutical drugs during the course of the project, but rather to address how insights and new approaches can be applied in clinical practice and implemented in guidelines and recommendations.

The action under this topic must contribute to all of the following outcomes:

• map and share insights from existing projects, pilots and datasets to get to a shared understanding of what the barriers and opportunities in the respective healthcare systems are in order to improve persistency and health outcomes for people living with chronic diseases;
• develop and implement new/revised collaborative models between public and private organisations with the aim of improving persistency and health outcomes;
• generate clinical and scientific evidence to demonstrate results in order to show the value of these new approaches and technologies;
• integrate new insights into the treatment regimen in close collaboration with people living with chronic diseases to improve disease outcomes;
• develop a consistent methodology/framework for measuring persistency using real-world data;
• develop recommendations and consensus reports with relevant healthcare stakeholders;
• optimise communication between healthcare systems and patients to improve persistency.

Scope:

The scope of this topic is to improve treatment persistency among people living with chronic diseases. According to the MEDI-VOICE project funded by the European Commission, non-adherence to medication accounted for approximately 200 000 deaths annually in the European Union, and according to a World Health Organisation (WHO) report from 2003, around 50 % of people living with a chronic disease do not adhere to the prescribed medication. From a recent analysis by Kvarnström et al (2018) [1], the major barriers for adherence to medication range from a lack of disease knowledge by the patient to logistical barriers like availability of medication and price (see list below), ultimately leading to discontinuation of medication.

The major categories of barriers identified are:

• patient specific, e.g. lack of knowledge, lack of routines, poor health literacy, gender, transition from paediatric to adult care, socioeconomic background;
• disease specific, e.g. lack of symptoms, lack of improvement, illness fatigue;
• treatment specific, e.g. side effects, complexity in dosages, inconvenience;
• healthcare and system specific, e.g., poor communication among stakeholders including e.g. physicians, patients, pharmacies, insurance providers, service providers, policy makers;
• social and culture specific, e.g. stigmas, religious belief, other alternatives;
• logistic and finance specific, e.g., price, renewal of prescription.

To address these barriers, this topic is expected to focus on the healthcare- and system-specific categories. The barriers to persistency identified in the list above are strongly interlinked, and in an effort to better understand the healthcare ecosystem in relation to persistency, it is the goal to especially explore the interface between the patient and healthcare providers. It is well-described that a lack of timely and accurate interaction/communication between patient and healthcare provider is key. Patients may lack education about their disease(s) and when support is minimal and there is insufficient patient counselling available, it can leave the patient with unanswered questions which might lead to discontinuation of their medication. In addition, social components, in particular health equalities including stigma and financial barriers, will also be in focus.

In this topic we propose a strong public-private coalition to help define and drive new models for collaboration across the healthcare ecosystem to improve persistency. This is to the benefit of patients as well as healthcare system sustainability by leveraging scalable technology that may hold the key to improving healthcare at the same time as providing it to many more individuals projected to have chronic diseases. A key component to successful implementation will be the patient voice and user experience.

It is planned to:

• share experiences and insights from existing pilots in specific healthcare environments and disease areas;
• use both observational and diverse clinical research methodologies to demonstrate impact, including health economics and outcomes research;
• drive fit-for-purpose studies to secure the evidence needed to maximise impact – particularly moving from test to scale;
• foster close collaboration between industry and academia within this field to ensure fast and feasible execution in real-world settings;
• build internal understanding & competencies within persistency to inform drug, study and service development;
• build training programmes for healthcare stakeholders;
• analyse how the new learnings/insights might be implemented in clinical treatment guidelines.

_{Reference :}

_{[1] Kvarnström K, et al. Barriers and facilitators to medication adherence: a qualitative study with general practitioners. BMJ Open. 2018}