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Medical Adherence and Digital Health Consortium: MADH-5


The CfBI Medical Adherence and Digital Health Consortium


Improving adherence through collaboration

A worldwide problem of striking magnitude (1)

Now in its fifth year, the CfBI Medical Adherence consortium brings together organisations from the pharmaceutical, medical device, pharmacy, systems integrator, and health information handling sectors together with clinicians, health care funders and regulators to jointly make progress in this complex area.

Sensitive to the constraints under which its members operate, the group has identified shared interests which can be efficiently pursued by a group of organisations with a global footprint to address the $ trillion problem which arises because patients do not always follow the advice of their healthcare practitioners.


A big problem. Poor medical adherence (also known as ‘medical compliance’ or ‘persistence’) is recognised as one of the major challenges facing health care delivery in all countries of the world. The World Health Organisation has estimated adherence to chronic medication as being typically 50% (1). More recent studies (2) have demonstrated adherence rates as low as 25%.

Low adherence causes problems for all parts of the healthcare system: the payers who are paying for higher hospital readmission rates, the pharmaceutical industry through reduced use of their drugs, and the doctors and patients through poorer clinical outcomes. The problem has been estimated as costing $300bn per year (3) in the  US alone.

A changing landscape. While not a new problem, the development of new technological approaches (‘Big Data’, ‘Internet of Things’, wearables, digital health and genomics) along with unprecedented cost pressures on the delivery of care mean that tackling poor medical adherence has gained new impetus.

The consortium approach. The size and complexity of the medical adherence problem makes it ideal for a multi-lateral consortium approach. This enables participants to: identify and explore common themes and obstacles; where appropriate identify and disseminate best practice; and jointly act to remove some of the barriers inhibiting the use of technology to improve adherence and so health outcomes.

The consortium

The consortium members include pharmaceutical companies, medical device providers, systems integrators, healthcare information handlers, private and public healthcare purchasers and providers, and leading academic experts in the field. The consortium is led by its industrial members and is international in scope – reflecting the geographical interest of the members but with an initial focus on Europe and the USA.

The goals of the consortium are defined by its members – its overall objective is to harness the capabilities and insights of its members to make substantive progress in this difficult area.

Participating organisations sign up to being consortium members for a year. The consortium is facilitated by CfBI using a tried and tested methodology. In all CfBI consortia, Chatham House rules are applied (discussions can be reported but not attributed) and there are no IP restrictions meaning that information exchange is rich, extensive, and immediately useful.

(1) WHO. (2003). Adherence to long term therapies - evidence for action. Geneva: World Health Organisation.

(2) Covvey, J. R. (2014). A comparison of medication adherence/persistence for asthma and chronic obstructive pulmonary disease in the United Kingdom. International Journal of Clinical Practice.

(3) DiMatteo. (2004). Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Medical Care.

Programme of work

Following early consensus forming meetings, the consortium is now focused on areas where obstacles are perceived as preventing widespread uptake of adherence initiatives and where it is considered that the consortium can make a real impact.

·         Adherence in clinical practice: focussing on the economic and regulatory barriers to real world adherence initiatives. The consortium feels that activities to improve adherence operate in what is often a failed market and has worked to characterise the nature of the failure and made recommendations for addressing this. the consortium has prepared a Position Paper recording its observations regarding the economic sustainability of adherence initiatives with a set of recommendations for real progress. This is available here [FULL and EXECUTIVE SUMMARY papers available].

·         Adherence in clinical trials: encouraging the measurement and reporting of adherence in clinical trials by ‘influencing the influencers’ (protocol standards bodies, regulators, journals, principal investigators). Consortium members have written an opinion piece that has been published by Nature Reviews Drug Discovery [LINK to https://www.nature.com/articles/nrd.2017.1]. The group is now preparing a peer reviewed paper that discusses practical considerations and recommendations for the effective measurement and reporting of adherence in trials. This will act as the unofficial companion to a recent ESPACOMP EMERGE guidelines for reporting adherence in trials.

·         The group is now considering how it should extend its thinking into the adjacent world of digital health – monitoring and measurement – and has started scoping a work stream in this area.

What’s in it for me / my organisation?

·         leverage the experience of other members rather than reinventing wheels;

·         influence the creation of agreed (and influential) ‘consortium positions’ regarding various aspects of improving medical adherence;

·         have a line of communication with funders/regulators: jointly influence regulatory and standards setting bodies;

·         network with your peers from other industries: participate in a confidential and vendor neutral environment;

·         link, inform and align the different strands of medical adherence activity within your organisation;

·         get the inside view on problems and suppliers which are not talked about publically;

·         use the ‘multiplier effect’ of the consortium to progress your agenda (subject to consortium agreement)

·         design the consortium agenda, topics and content to ensure it satisfies your needs. 

Please contact Jeremy Holland (Jeremy.holland@cfbi.com) for more information.