Motivating patient behavior to improve adherence and early drop-out rates

Patient non-adherence is a major issue

Poor patient adherence to treatment is a growing and worldwide problem and it has a negative effect on health outcomes and health-care costs.

It contributes to an estimated 200.000 premature deaths in the EU each year, costing as much as € 125 billion each year in avoidable hospitalizations, emergency care, and adult outpatient visits.

For the US it has been assessed at somewhere between $100 to $300 billion , representing 3% to 10% of total US health-care costs.

A Critical Success Factor for Clinical Trials


Clinical trials account for over 45% of the annual worldwide pharmaceutical R&D spending, which is expected to reach $232 billion by 2026 .

Early drop-out, an extreme form of patient non-adherence, has been identified as one of the main reasons for extended trial timelines and budgets. However, despite all patient-centric measures taken, recent studies still show that the average early drop-out rate seems to be stagnant at 25% .

With the number of clinical trials growing each year, recruiting suitable patients will get more difficult and more expensive. It is obvious that patient adherence and retention both are critical success factors.

Human behavior, the key to improving patient adherence

As early as in 2003 the World Health Organization (WHO) stated that adherence has a tremendous effect on the health of the population. The key to improving adherence lies in managing individual human behavior .

A person’s behavior towards health care is mainly driven by how he or she perceives and experiences reality in general and health in particular. This implies that the experience of health may differ substantially between individuals, with obvious consequences for health related behavior; individuals with identical biomedical diagnoses may vary substantially in terms of health experience and consequently in health related behavior.

improving performance and adherence

To improve patient adherence and retention during clinical trials, Link2Trials has developed a methodology based on the principles of the Subjective Experienced Health Theory, created by Prof. Dr. Sjaak Bloem of the Nyenrode University (Netherlands) .

Subjective Experienced Health is impacted by two determinants: perceived control and acceptance. Depending on the level of both determinants, a patient’s behavior matches a specific profile that predicts the level of adherence. Interactions and interventions that meet the requirements of an SEHM profile will motivate a patient to maintain or improve that level of adherence.

providing the right level of support

Since the level of perceived control and acceptance is influenced by the patient’s experiences over time, his or her level of adherence is also affected. The Subjective Experienced Health Methodology (SEHM) enables clinical trial HCP’s to provide a patient personalized support at the right level, at the right time and in the right form.

Five Key Steps

The SEHM methodology consists of five key steps:
  1. Identify the top risk factors of non-adherence for your clinical trial
  2. Develop a communication and support package for each risk factor, tailor-made for the SEHM profile. This package is designed to motivate patient adherence and minimize the risk of an early drop-out.
  3. Push the right information to each patient, based on their up to date SEHM profile. Each patient will:
    • Get the right information in the right form
    • Get the right level of support at the right time
    • Feel acknowledged, appreciated and treated as an individual again
  4. Send alerts to the clinical trial team if and when a patient’s SEHM profile moves into the high-risk zone.
  5. Clinical trial team contacts high risk patients, schedules face to face meetings to listen to their story and supports these patients to overcome their challenges.

SEHM is supported by an online platform, is scalable, easy to use and easy to implement.

TrialCoach application on a pc
TrialCoach application on a tablet
TrialCoach application on the phone

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