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Prescribed but Not Worn: How a Wearable Cardiac Monitor Company Used Market Research and IDIs to Understand Why Patient Activation Rates Were Falling Well Below Prescription Volumes

Prescribed but Not Worn: How a Wearable Cardiac Monitor Company Used Market Research and IDIs to Understand Why Patient Activation Rates Were Falling Well Below Prescription Volumes

Executive Snapshot

Client

Wearable Cardiac Monitor Manufacturer, United States

Situation/Challenge

The client manufactured ambulatory cardiac monitors prescribed for arrhythmia detection in outpatient cardiology settings. Prescription volumes had grown strongly over two years following expanded reimbursement coverage, but the proportion of prescribed patients who completed the onboarding process and actually wore the device for the prescribed monitoring period was running at well below the clinical team's expectations. The gap was generating two problems simultaneously: incomplete diagnostic data for cardiologists and unrecovered device costs for the company when prescribed units were not activated. The commercial team had no clear picture of what was happening between the prescription and the patient wearing the device.

Objective

Commission a wearable cardiac devices market research report benchmarking patient activation and completion rates at comparable ambulatory cardiac monitor programmes, then conduct structured IDIs with patients who had been prescribed but had not activated the device to understand the specific barriers between prescription and use.

Constancy Researchers Solution

Market Research Reports combined with Primary Research & VoC through In-Depth Interviews (IDIs), a Wearable Cardiac Devices Market Report benchmarking activation and completion rates, followed by 31 IDIs with patients who had received a prescription but had not completed activation of the monitoring programme.

Impact

Market research confirmed that activation gaps were a well-documented challenge across ambulatory cardiac monitoring programmes, with the onboarding complexity and technology anxiety among older patient demographics being the most consistently identified barriers. IDIs revealed that the specific barriers for the client's patients were concentrated around two points: a smartphone-dependent activation process that excluded or intimidated a large share of the elderly patient population, and a lack of proactive follow-up from the prescribing cardiology practice after the prescription was issued.

Client Outcome

The client introduced a landline-compatible activation option, a patient support phone line staffed during clinical hours, and a prescribing practice notification alert at seventy-two hours for unactivated patients. Activation rates improved by over thirty percent within two clinical quarters.

The Situation / Challenge

Wearable cardiac monitoring occupies an unusual position in the medical device pathway because the prescription decision and the patient activation decision are separated by an onboarding process that happens outside the clinical setting. A cardiologist prescribes the device in a clinic conversation.

The client’s commercial team was aware that activation was a problem but had attributed it broadly to patient compliance without examining which specific steps in the activation journey were generating the most friction. The prescribing cardiologists, when asked informally, tended to view non-activation as a patient motivation issue.

The commercial reality was straightforward: every prescribed device that was not activated represented an unrecovered device cost, an incomplete diagnostic cycle for a patient who needed monitoring, and a cardiologist whose confidence in recommending the device to future patients was being quietly eroded by the experience of patients returning to follow-up without data.

Key Challenges

  • No market benchmarking of activation and completion rates at comparable ambulatory cardiac monitoring programmes to understand whether the client’s activation gap was typical or worse than comparable programmes.
  • No direct research into the specific barriers that were preventing patients from completing the activation process after receiving a prescription.
  • A commercial team attributing non-activation broadly to patient compliance without identifying which specific activation steps were generating the most friction.
  • An elderly-skewing patient demographic that may have been poorly served by a smartphone-dependent activation process designed for a more digitally confident user.
  • No structured feedback mechanism from prescribing practices identifying which patients were failing to activate before a missed follow-up appointment revealed the gap.
  • Device cost recovery and diagnostic completeness both being undermined by an activation gap the company did not fully understand.

A wearable cardiac monitor that a patient does not activate is clinically equivalent to one that was never prescribed. The prescription decision is the cardiologist’s. The activation is the patient’s. When those two events are separated by an onboarding process with no proactive support and no feedback loop to the prescribing practice, the gap between them is determined entirely by factors the manufacturer has never designed for.

Constancy Researchers Solution

Constancy Researchers benchmarked activation and completion performance across comparable programmes and then went directly to the patients who had not activated to find out what the onboarding process had actually looked like from their side of it.

Wearable Cardiac Devices Market Report: Activation & Completion Benchmarking
  • Delivered a market research report benchmarking patient activation rates, onboarding completion rates.
  • Found that activation gaps were well-documented across the ambulatory monitoring category.
In-Depth Interviews (IDIs) with Non-Activating Patients
  • Conducted 31 structured IDIs with patients who had received a prescription for the client’s ambulatory cardiac monitor but had not completed device activation, exploring the specific moments in the onboarding process where they had stopped, the reasons they had not continued, and what would have helped them complete the process.
  • Found that two barriers dominated the non-activation accounts: a smartphone-dependent activation process that a significant share of elderly patients either could not complete without assistance or had not attempted because they did not own a compatible smartphone, and an absence of any follow-up contact from the prescribing practice or the manufacturer after the prescription was issued.
Technology Access & Digital Confidence Analysis
  • Analysed the IDI findings by patient age and self-reported technology confidence.
  • Found that the smartphone activation barrier was heavily concentrated in patients over seventy.
Prescribing Practice Feedback Loop Gap Analysis
  • Examined the communication flow between the client’s activation system and prescribing cardiology practices.
  • Found that prescribing practices received no proactive notification of unactivated patients.
Activation Pathway Redesign & Practice Alert Programme
  • Recommended a landline-compatible activation option for patients without smartphones, a staffed patient support line during clinical hours.

The engagement replaced a general patient compliance attribution with a specific, process-level diagnosis and three targeted changes that addressed the actual barriers IDI participants had described.

Impact

  • Market benchmarking confirmed activation gaps were common across ambulatory monitoring programmes, especially in older patient demographics.
  • IDIs identified the smartphone-dependent activation process as the primary barrier for patients over seventy.
  • The absence of any prescribing practice notification for unactivated patients was confirmed as a systemic feedback gap.
  • A landline-compatible activation pathway was introduced for patients without compatible smartphones.
  • A staffed patient support line was established for clinical-hour activation assistance.
  • An automated seventy-two-hour alert to prescribing practices for unactivated patients was implemented.
  • Activation rates improved by over thirty percent within two clinical quarters.
  • Prescribing cardiologists began receiving actionable information about non-activating patients in time to intervene before the monitoring window was lost.

Client Outcome

Activation Improvement

Activation rates improved by over thirty percent within two clinical quarters of implementing the three targeted changes.

Technology Barrier Removed

A landline-compatible activation option addressed the primary barrier for the elderly patient segment.

Prescriber Feedback Loop

Seventy-two-hour unactivated patient alerts gave cardiologists timely information to follow up before the monitoring window was lost.

Patient Support Added

A staffed support line during clinical hours gave patients without household technology assistance a direct route to activation help.

Cost Recovery Improved

The activation rate increase reduced the share of prescribed units generating unrecovered device costs.

Diagnostic Completeness

More monitoring cycles were completed, giving cardiologists the arrhythmia data the prescription was intended to produce.

Cardiologist Confidence

Fewer patients returning to follow-up without data reduced the quiet erosion of cardiologist confidence in recommending the device.

Demographic Insight

The IDI analysis identified the over-seventy patient segment as disproportionately affected, enabling the client to design future onboarding with this demographic's needs explicitly in scope.

Market Positioning

The device company was repositioned as a manufacturer that understands and designs for the patient's activation journey rather than assuming prescription volume translates to monitoring completion.

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