The 4S; The Fail-Proof Method for measuring a PSP success

No one can miss the scene of pain, ache, and agony on a patient’s face. Several professionals work diligently to help relieve every patient’s suffering.

However, our role - as medical strategists - is to help partially ease their worries by ensuring they get full access to their treatment.

In my role as market access Director, I always try to seize every opportunity to serve the patients and impact their lives by providing different access solutions, which include “Patient Support Programs (PSPs)”.

For the last 15 years I have worked closely with policy makers to continuously improve and develop the right PSPs for the Middle East, and I had learned that there are key pillars to a successful PSP with the patient centric outcome, if it was tracked and monitored correctly.

In this article, I will be sharing the 4 key pillars for developing a successful and impactful PSP. Moreover, I will dig deep to better explain how different PSPs models and approaches can yield different outcomes.   

Imagine you have two patients who were both diagnosed correctly, prescribed professionally, and secured their treatment pack successfully, but were introduced to two different PSP models. What do you think can impact the patient outcomes? How can different PSP models affect patients differently? And why would one program succeed but not the other? 

I believe that the mean to guaranteeing a successful and effective PSP is the 4S methodology;

START. SUSTAIN. SURPASS. STRATEGY. 

START 

Did you know that one study reported that 7 out of 10 patients would be compliant with their treatment if only they got the chance to better understand their disease and how their treatment can help them?

And, did you know that in cancer pain management in the UK, they discovered that only 40% of patients were complaint to their cancer pain treatment?

Our healthcare providers are facing critical challenges from capacity and time constraints perspectives. A well-structured and well-balanced PSP with appropriate scientific content, in addition to methods on how to handle a patient psychology can get the patient aquatinted and set proper expectations.

The START phase is a stepping stone that can pave the way. It comes when the patient needs more, so my advice here is to START strong given that first impressions last.

If your PSP succeeded in the START phase, then congratulations, you got the patient’s attention and more importantly, their trust. Unfortunately, this will not guarantee keeping the patient sustainably in the program, do you know why?

SUSTAIN 

This is when the SUSTAIN phase intersects.

Statistics show that:

• 1 out 4 patients stop their treatment due to side effects
• 1 out of 5 patients stop as they believe that they got better
• Almost 66% of patients tend to stop because they simply forgot

To summarize, even if the disease is the same and the treatment is same, patients have different experiences. The way they experience and handle the symptoms is also different.

The PSP should be unique for every patient. To ensure the sustainability of the patient in any program, you will need to design a program that is flexible enough to differently serve each patient’s needs. Use the SUSTAIN approach as the success of a PSP program, which will be measured by the number of patients who are not only retained, but also benefiting the most. 

Now, we successfully secured the START and SUSTAIN, but that’s not all… there’s still a long way to go.

SURPASS

8th, was how patients ranked the financial benefit against other PSP benefits in a survey conducted in Philadelphia, USA. This denotes that patients have more important needs other than the financial and the materialistic aspects. For that reason, a successful PSP should be serving patients beyond the disease and the treatment management.

A successful PSP should be SURPASSING all expectations.

Imagine a PSP which can help patients acquire a new habit, one that can give them new opportunities to be interactive and more productive. Imagine a PSP which can help patients expand their network of friends and a social network. This will definitely help the patient to have the sense of purpose in life. The thing that will give them hope and motivate them more.

Surpass the patients’ expectations. It is not only about the disease or the treatment; the patient is going into a new chapter of life. Help the patient to have a meaning and sense of purpose in this chapter.

A patient has a disease, but that does not mean that this patient doesn’t have a life to live.

By now, we explored three out of the 4Ss, START, SUSTAIN, and how to SURPASS all expectations. But before taking you to the 4th S, let me ask you one question, did you ever try to acquire a new skill or to create a new behavior, such as quitting smoking or going to the gym, was it easy?

STRATEGY 

A number of studies concluded that it might take someone from two to eight months to create a new habit, provided that this person has the will. Now imagine the time and effort needed if the person is reluctant, will it be easy?

Our last S is for STRATEGY, and to have a strong strategy while building or measuring a successful PSP, we need to factor the number of services and the tangible solutions beside the psychological and behavioral aspect. Don’t bet only on the tangible services, focus also on how the PSP will make the patient feel, and how the patient will live his or her new life.

These are the 4Ss; START. SUSTAIN. SURPASS. STRATEGY.

If you want to build and track the success of any PSP, the 4S will guide you to reach to the desired outcome.

To conclude, we need to always remind ourselves:

Why do we need PSPs?

Pharmaceutical companies are continuously exploring new breakthroughs and launching new treatments. Health authorities are exerting all their efforts to secure the proper access to these treatments. But if patients were not able to gain the maximum benefit from these innovations, then all these efforts will be in vain.

And what is a PSP?

It is a sequence of actions that are meant to influence two major factors:

1. The ability of the patient to manage the disease challenges and to adhere to treatment; the aspect which covers all the materialistic services.
2. The willingness of the patient to adhere to the treatment, which includes the psychological and behavioral elements; the aspect that can keep the patient motivated and engaged. 

Then comes the how?

My recommendation is to follow the 4Ss; START. SUSTAIN. SURPASS. STRATEGY. I truly believe that they can guide any PSP to reach the desired impactful patient-centric outcome.

Finally, allow me to share with you a personal story, that anchored my views significantly and helped me to shape the 4Ss concept.

As I early mentioned, I have been in this field for the last 15 years, where I have encountered many insights and feedback regarding cancer patients; their challenges, their needs, and what they aspire for. I thought that I know a lot or even I know it all, until my mother passed away from cancer three months after her diagnosis, at the time, I thought that at least I will be able to understand her challenges and her needs and be able to guide her through her disease and treatment stages. Unfortunately, this wasn’t the case. I remember the way my mother used to articulate her pain and needs, which were totally different from what I used to know.

It is impossible to feel exactly every patient’s suffering. The patients are usually talking, but the question will always be:

Are we truly listening? 

References:

• Survey published by pharmacy automation company Omnicell in 2015
• 2018 survey by the Canadian Partnership Against Cancer (CPAC)
• Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl & J. Beckmann (Eds.), Action Control: From Cognition to Behavior (11-19). Berlin: Springer Berlin Heidelberg.
• Brown, M.T., & Bussell, J.K. (2011). Medication adherence: WHO cares? Mayo Clinic proceedings, 86(4), 304-314. doi: 10.4065/mcp.2010.0575
• Capgemini Consulting. (2012). Estimated annual pharmaceutical revenue loss due to medication non-adherence [White paper]. Forissier, T., & Firlik, K.
• Cook, P.F., Schmiege, S.J., Mansberger, S.L., Sheppler, C., Kammer, J., Fitzgerald, T., & Kahook, M.Y. (2017). Motivational interviewing or reminders for glaucoma medication adherence: Results of a multi-site randomised controlled trial. Psychology & Health, 32(2), 145-165. doi: 10.1080/08870446.2016.1244537
• Crawshaw, J., Auyeung, V., Norton, S., & Weinman, J. (2016). Identifying psychosocial predictors of medication non-adherence following acute coronary syndrome: A systematic review and meta-analysis. Journal of Psychosomatic Research, 90, 10-32. doi: 10.1016/j.jpsychores.2016.09.003
• Emilsson, M., Gustafsson, P.A., Ohnstrom, G., & Marteinsdottir, I. (2016). Beliefs regarding medication and side effects influence treatment adherence in adolescents with attention deficit hyperactivity disorder. European Child & Adolescent Psychiatry. doi: 10.1007/s00787-016-0919
• Ferguson, C., Inglis, S.C., Newton, P.J., Middleton, S., Macdonald, P.S., & Davidson, P.M. (2017). Barriers and enablers to adherence to anticoagulation in heart failure with atrial fibrillation: Patient and provider perspectives. Journal of Clinical Nursing. doi: 10.1111/jocn.13759
• Fisher, A. (2016, January 20). New Year’s Resolutions Already Wobbling? How To Get Back on Track. Retrieved from https://fortune.com/2016/01/20/new-years-resolutions-commitment/
• Griva, K., Davenport, A., Harrison, M., & Newman, S.P. (2012). Annals of Behavioral Medicine, 44(1), 85-93. doi: 10.1007/s12160-012-9359-4
• Lehrer, D.S., & Lorenz, J. (2014). Anosognosia in schizophrenia: Hidden in plain sight. Innovations in Clinical Neuroscience, 11(5-6), 10-17.
• Lin, C.Y., Updegraff, J.A., & Pakpour, A.H. (2016). The relationship between the theory of planned behavior and medication adherence in patients with epilepsy. Epilepsy & Behavior, 61, 231-236. doi: 10.1016/j.yebeh.2016.05.030
• Manning, M., & Bettencourt, B.A. (2011). Depression and medication adherence among breast cancer survivors: Bridging the gap with the theory of planned behavior. Psychology & Health, 26(9), 1173-1187. doi: 10.1080/08870446.2010.542815
• Nease, B. (2017). Why Fifty Bits? Retrieved from https://www.fiftybits.com/why-fifty-bits/
• NEHI. (2011). Improving patient medication adherence: A $290 billion opportunity.
• Okoro, O., & Odedina, F.T. (2016). Improving medication adherence in African-American women living with HIV/AIDS: Leveraging the provider role and peer involvement. AIDS Care, 28(2), 179-185. doi: 10.1080/09540121.2015.1071771
• Stringham, J., Ashkenazy, N., Galor, A., & Wellik, S.R. (2017). Barriers to glaucoma medication compliance among veterans: Dry eye symptoms and anxiety disorders. Eye & Contact Lens. doi: 10.1097/ICL.0000000000000301