Relex Health is a professional medication management company, headquartered in Bengaluru, India. Medication adherence plays an important role in controlling chronic conditions, treating temporary conditions, and overall long-term health and well-being.

There are evidences to show prevalence of medication non-adherence, especially in chronic care patients. A growing concern is the associated adverse outcomes and higher costs of healthcare which could lead to hospitalization and even fatality.

Chandrashekar Kini, Co-Founder and Director, Relex Health, tells us more. Excerpts from an interview:

DQINDIA Online | DATAQUEST

Chandrashekar Kini, Co-Founder and Director, Relex Health

DQ: Can you tell us about Relex Health and how the Relex Health program helps patients?  What is the impact of medication non-adherence on the individuals?

Chandrashekar Kini: Relex Health Services India Pvt Ltd (Relex Health) was born on 27th May 2019 to fulfil the vision of its founders to make a difference to the lives and well-being of patients with chronic illnesses like Diabetes, Hypertension and other Cardio Vascular diseases, COPD, etc.

Relex has developed a practical but effective solution, for problems related Medication Adherence. Relex founders have 60 years of combined domain experience and the program and business design emerged from their experience and insights.

Medication non-adherence is the intentional or unwitting failure to take medications as prescribed.

By not following the prescriber’s orders correctly, the patient will experience decreased effectiveness of treatment which can lead to the worsening of their condition. Worsening of condition leads to complications which tend to be irreversible leading to deterioration in quality of life, increased costs of healthcare, potential for serious adverse events, and even death.

Chronic diseases, which have shown an inexorable growth in India over the last decade present a problem of particular concern.  Between 2007 and 2017, chronic diseases have moved to rank significantly higher in causes of death in India.

Data from IHME shows that while the ischemic heart disease continued to occupy the top spot, COPD moved from No.3 to No.2, stroke from No.6 to No.3, diabetes from No.13 to No. 9 and chronic kidney disease from No.14 to No.10. With the arrival of Covid19 in India, the problem is highlighted even further. Patients with chronic diseases and co-morbidities have been identified at significantly higher risk than the rest of the population

The Relex Medication Therapy Management Program is a structured program delivered by qualified professionals at the home of the patient dealing with chronic or lifestyle diseases. Prescriptions for medication are digitized and reviewed by Relex qualified professionals leveraging its knowledge base.

Patients receive detailed, ongoing guidance on the correct use of medicines. Their progress on outcomes and Medication Adherence is systematically and diligently monitored including the prompting of timely doctor visits as well as lab tests. The Relex program is personalized and high in convenience and takes charge of complete medicine management for the patient

The Relex program provides a supportive bridge between patients and their doctors that facilitates the fine-tuning of their treatment. It is preventive and facilitating in nature and supports behaviouralchanges in patients with consistent knowledge improvement and monitoring

DQ: What is the estimated potential market in India and globally?

Chandrashekar Kini: Relex is the first in India to bring out a Medication Therapy Management Program in India. To our knowledge, there is no equivalent program in the country.

The size of the opportunity is reflected in the estimate that close to 40% of pharma industry sales amounting to around Rs 75,000 crore caters to chronic diseases and is growing at 10-11% per annum. India has the largest population of patients for Diabetes alone which is expected to rise to 134 million by 2025.

Non-adherence is also a worldwide problem. A WHO report of 2003 identified that among patients with chronic illness, approximately 50% do not take medication as prescribed. A report in US Pharmacist highlights that in the USA, Non-Adherence can account for up to 50% of treatment failures, around 125,000 deaths and up to 25% of hospitalizations each year.

In the UK, as per the European Journal of Hospital Pharmacy, approximately GBP 500 million could be potentially saved if adherence was improved in five key health categories. Though clear data and trends on Medication Non-Adherence for India are difficult to come by, anecdotal evidence points to the situation here being serious

Global revenues for Medication Adherence and Medication Therapy Management solutions are estimated at USD 6 billion and growing rapidly in double digits. Between 55-60% of this is realized in the US. The potential is substantially larger

DQ: What are the key steps to be taken by the industry and doctors to achieve the full potential of Medication Adherence?

Chandrashekar Kini: Doctors in India devote considerable professional time in ensuring that their patients with chronic illnesses receive appropriate treatment.

Relex is the first in India for having designed and launched a Medication Therapy Management Program in 2019 to drive Medication Adherence which will be a bridge of support to patients and doctors in their endeavor to achieve better outcomes.

We would look forward to working closely with the medical fraternity to recognize the emerging public challenge presented by chronic diseases and Medication Adherence, and in this endeavor reach the full potential in terms of positive impact on the lives of such patients. Covid19 has made the need for such a program even more tangible.

DQ: What is the impact of Covid-19 on medical adherence?

Chandrashekar Kini:  Covid–19 has impacted patients of chronic diseases and their Medication Adherence in different ways:

The need to minimize risks for patients with chronic diseases has never been greater.  Medication Adherence has a key role to play. Kretchy, Asiedu-Danso and Kretchy highlight that Covid–19 is best combated with a stronger immune system. Chronic diseases like HIV, diabetes or kidney diseases leave patients more vulnerable to infections. 

Stress and anxiety associated with Covid–19 lockdowns, and changes in the way of life, triggered by Covid–19, may negatively impact patients with cardio-vascular diseases whose development and management are linked to stress and anxiety and erode health gains made prior to Covid–19. The presence of co-morbidities raises further concerns. Among patients with diabetes in India, cardiovascular risk factors appear to be highly prevalent.

The Covid–19 pandemic has presented other challenges to Medication Adherence for patients with chronic illnesses. The first lock-down in India commencing 24th March 20 struck at short notice. Sudden bottlenecks in the supply chain presented challenges in availability and delivery arrangements of medication for patients with chronic illness during the lockdown. With doctor clinics and hospital OPDs shut and patients confined to their homes, routine follow up, review of treatment and prescription was dislocated.

The first lockdown was lifted after 50 days. Yet, rapid spread of Covid19 infections in the unlock phase, perceived enhanced infection risk and social distancing concerns have kept the flow of patients to clinics and hospital OPDs at low ebb.

Today’s activity is a far cry from the pre-Covid19 period. Follow-on lockdowns to contain the spread of Covid–19 continue to impede recovery in clinic and hospital OPD activity. The silver lining is substantial growth in patient outreach through telemedicine. Guidelines for telemedicine practice in India have been recently launched. One can expect to see further development in the near future.

While the Covid–19 pandemic draws healthcare resources away from routine follow up and treatment, other healthcare issues may be appearing on the horizon.  Gaps in care of patients with other ailments, especially chronic diseases, in the short term, can lead to long-term burden on healthcare. This is particularly worrisome, given the significant growth in disease and mortality connected with chronic illnesses in our country. Medication adherence is central to managing this.

Covid–19 has created fertile ground for heightened consciousness and rapid growth in awareness of medication adherence in India. The need is also top-of-the-mind for doctors as support for driving better healthcare outcomes for patients with chronic illnesses. These critical factors will strongly drive demand for effective Medication Adherence solutions. In diabetes alone, it is time for medication adherence to receive the focus and attention it deserves. 

DQ: Can you tell me your plans about acquiring customers amidst the current lockdown?

Chandrashekar Kini: Relex will be connecting in different ways with patients for chronic illnesses and potential for benefiting from the Relex Medication Therapy Management Program. In thephysical domain we aim to reach them through doctors, gated communities and other similar opportunities. With many individuals either staying or working from home in the environment generated by Covid–19, digital marketing efforts are also expected to emerge as an effective channel to reach such patients.

As we commence our expansion and growth, Relex is privileged to have received substantial referrals from our patient base even at such early stages.