Steven R. Feldman, M.D., Ph.D., a practicing dermatologist at Wake Forest Baptist Medical Center, treats patients with difficult, resistant skin conditions. Many people focus on problems with making the right diagnosis or prescribing the right therapy as the critical elements in treating resistant diseases. In many cases, however, the path to better health simply involves getting patients to use their medication better.
Feldman spent the greater part of the 2000s researching this problem in his patient population. His research team used electronic monitors on medication bottles to measure how well their patients adhered to their medications and the relationship between adherence and outcomes.
“We knew that many of our patients weren’t fully adhering to our care plan,” says Feldman, “but we had no idea how bad their adherence actually was.”
Data from initial studies showed that patient adherence to acne medications averaged only about 30% percent.
Feldman changed the way he practiced, focusing not just on making the right diagnosis and prescribing the right treatment, but also on getting patients to use their medications better. His patients’ treatment outcomes were often nothing short of appearing miraculous. At the same time, Feldman’s research team shifted gears. They began experimenting with new ways to improve patient adherence.
“We started with two premises,” says Feldman. “First, that a doctor’s job doesn’t end after he or she prescribes a treatment. And, second, that adherence is not solely the responsibility of the patient.”
The first, most fundamental, component of getting patients to use medication is to assure that the patient feels cared for. Patients who don’t feel cared for may not trust their doctor and may not use their medication. Feldman worked on this issue on an earlier entrepreneurial endeavor.
In addition to make sure patients felt cared for, Feldman’s research team found that the timing of office visits has an enormous effect on patients’ use of medication. Feldman relates this to his own experiences as a dental patient. “I floss my teeth every day,” says Feldman, “but I start flossing them twice a day before dental appointments.”
Feldman coined this behavior the dental floss effect. Others call it the white coat effect. The closer you are to a physician visit, the more likely you are to take your medications.
Feldman and his team tested multiple strategies to mimic the white coat effect in their trial patients. They sent email and text reminders. They scheduled follow-up appointments with nurses. They called parents to remind their children.
In the end, what they found to be the most effective and cost-appropriate solution was extraordinarily simple and powerful. “We found that if we regularly administered an online survey to our patients designed to make patients feel cared for, our patients’ adherence would skyrocket.”
In their preliminary research in acne patients, Feldman and his team were able to increase adherence rates by more than 100 percent, and they were able to do it without having to use any physician or office time.
Today, they are testing the survey in patients with high cholesterol, high blood pressure, diabetes and depression. And the survey is being marketed under a new startup company, Causa Research.
Led by serial entrepreneur, Robert Anderson, Causa is taking Feldman’s research and applying it to the real world. The company is in conversations with pharmaceutical companies, leading insurance providers and pharmacies, all of whom are investigating ways to use Causa Research’s patent-pending survey to help increase adherence to medications and improve outcomes.
Wake Forest Innovations announced an exclusive licensing agreement with Causa on September 12, 2013. “This is another excellent example of our innovative technologies being commercialized,” said Eric Tomlinson D.Sc., Ph.D., chief innovation officer at Wake Forest Baptist. “Causa Research’s technology has the potential to transform not only the lives of patients across the world, but also reduce health care costs.”
The business value of the survey is immense. For pharmaceutical companies, it can support the effectiveness of their therapeutics, thereby increasing use. For insurance companies, it can support the effectiveness of generic and other low-cost medications, minimizing the needs for patients to shift to higher-cost care solutions. Improving patients’ adherence levels can also improve insurers’ Star ratings. And, for patients and integrated health care systems, it translates to better outcomes and healthier lives.
“I became a doctor to help patients get well, not just to make the right diagnosis and prescribe the right treatment,” says Feldman. “I became an academic doctor to help other doctors help patients too. But Causa Research does more than even that. It helps the entire health care system – health care providers, pharmacies, pharmaceutical companies, insurance providers and, of course, patients – work together for the betterment of health.”
Learn more at CausaResearch.com.