Doctors are only part of the patient care equation. Physicians can take steps to make sure that they’re prescribing in-depth, comprehensive, and highly effective treatments plans – but at the end of the day, it’s the patient’s responsibility to follow through.
Image source: news.vanderbilt.edu
The problem is, patients struggle to stick to their treatment plans – according to the CDC, 20 to 30 percent of prescriptions are never filled. In about 50 percent of cases, medication is not continued as prescribed. These trends hurt every party involved.
Study after study shows a strong correlation between treatment nonadherence and illness relapse rates. When patients don’t take their medications, they get sicker.
On a per-patient basis, nonadherence costs $2,000 every year.
According to analysis published in the Annals of Internal Medicine, nonadherence costs U.S. healthcare providers anywhere between $100 and $289 billion each year.
Nonadherence causes 30 to 50 percent of treatment failures and 125,000 deaths annually.
Non-adherence to cardioprotective medicines increased the risk of cardiovascular hospitalizations by 10 to 40 percent and mortality by 50 to 80 percent.
Can patients keep up?
What’s important to keep in mind is that the reasons are not always grounded in science – they’re sociological, psychological, and economic. Treatment nonadherence stems from a series of everyday decisions.
People are busy and don’t always have breathing room to remember to take a pill.
Patients may experience complications or discomfort and react – out of fear – by stopping treatment altogether.
Patients stop seeking treatment when they don’t see an immediate benefit.
People are afraid of social stigma associated with a particular medicine.
Patients have trouble retrieving their medicines from a pharmacy.
The CDC points out that roughly 11 percent of those prescribed treatment lack the financial resources to work with a seek follow-up care.
What’s important to keep in mind is that nonadherence is far from the patient’s fault. Blame-games will only cause a rift between physicians and healthcare consumers. When people are sick, they’re experiencing complex emotions and are likely to be feeling stressed or vulnerable.
Communication and Self-Management Are Key
Patients need a support system to self-manage their care. The problem is that doctors are time-strapped. Physicians spend just half of their days engaging face-to-face with patients, and on average, primary care office visits last just 10 minutes.
It’s unrealistic to assume that patients are getting the information that they need from the few minutes that they’re spending with doctors. Patients need to self-direct their own education care. The problem is, they don’t necessarily know it.
Again, it’s not the patient’s fault – they don’t work in healthcare, and they aren’t medical researchers either. They’re taught to believe that doctors have all the answers, when in fact, they should also be relying on expertise from pharmacists, therapists, medical researchers, published studies, nurses, physician’s assistants, and other experts.
It’s unrealistic (and unhealthy) to expect patients to simply ‘figure it out.’ It’s up to providers to invest resources in continued education, in and out of the doctor’s office.
That’s where technology comes in. The following innovations have the potential to boost medication adherence, cut costs, and ultimately – prolong lives.
1. Cloud-Based Medication Support
People are impatient. They don’t have time to wait in long lines at the drugstore – especially when they can just use the drive-through pharmacy instead. We’ll typically grab our medications as part of an errand, start treatment based on directions, and run before fully understanding what we’re doing.
All of a sudden, we experience a side effect, and we don’t know what to do. It’s midnight, we’re scared, and the pharmacy is closed. We hop online to research ‘expert’ answers from medical communities – only to find unreliable information from untrustworthy medical content providers.
We instantly conclude that the best option is to stop treatment immediately. The problem is, patients aren’t in a position to make that judgment call. An on-call doctor may not be the right person to ask in the heat of the moment either.
Last year, a mobile app called iRetainRx attempted to address this challenge by proposing a cloud-based system to help patients and caregivers connect with pharmacists and providers. Using a mobile device, patients could use iRetainRx to get a video link to their pharmacist to get immediate answers. The app placed as a semifinalist in last year’s Sanofi US’ Data Design Diabetes Innovation Challenge.
Image Source: iRetainRX
While an interesting concept, this technology may be far away from actual implementation. The iRetainRX app is currently unavailable for download and its status is unknown.
2. Peer-to-Peer Pill Reminders
Our friends and family are mission-critical to our health and wellness. More often than not, we rely on our parents, children, brothers, and sisters to make sure that our recovery and treatment plans are on track.
That’s the inspiration behind MediSafe, an iOS and Android mobile app (and cloud-synced database) that provides treatment adherence programs for patients, their parents, their family, and friends. The concept is simple —
MediSafe will alert family members when a patient has not taken his or her meds.
Image Source: MediSafe
As of September 2013, MediSafe offers solutions for healthcare businesses to deliver personalized medication reminders to patients. Notifications can be modified in real-time using predictive analytics to alter the provider’s messaging (and video).
As of January 2013, users of the app have reported an adherence rate of 81 percent. With Statin drug users, adherence levels were 85 percent.
In early 2014, MediSafe will become accessible to people without smartphones via an automated phone system and SMS. Patients will be able to record medication doses via touch tone, and family members will be able to receive alerts via SMS.
3. Text Messages
It’s hard to believe that text messages have been around for over a decade. It’s only in the last few years, however, that researchers and providers have connected this technology to healthcare.
A March 2012 study (based on two randomized controlled trials) found that short, weekly text messages boosted adherence to antiretroviral therapy among a population of HIV patients in Kenya. The authors concluded that clinics and physicians should consider implementing these programs to remind patients to take their medicines — especially in high-income countries and among adolescent populations.
A 2011 study funded by Microsoft and conducted by John Hopkins University found similar patterns. The study followed 429 glaucoma patients, with one group using Memotext’s patient adherence software (and Microsoft’s online health portal) and a control group that was not exposed to these technologies.
When patients used combined technologies, researchers found a 16 percent increase in medication adherence. The control group saw no change in adherence.
Image Source: Mosio
4. Smart Pills
Also known as the ‘SmartPill,’ Ingestion Event Marker was cleared by the FDA in July 2012 for marketing as a medical device.
This single-use, ingestible capsule allows physicians to monitor their patients’ pressure, pH, and temperature in the GI tract. The pill is slightly larger than a multivitamin and is equipped with data tracking technology.
The SmartPill connects patients and physicians through the following steps:
- Patients eat a small meal before swallowing the pill.
- Once swallowing the SmartPill, patients can resume their normal routines, however, they must wear a data receiver around their necks.
- The physician can then download patient data.
Another type of smart pill includes an embedded microchip that records specific details about a patient’s medication program. Data is then transmitted to a “receiver” patch around the patient’s arm. The receiver then sends an alert to the patient’s smartphone.
Image Source: Proteus Digital Health
The microchip can monitor how much drugs are taken when the dose is administered, and when the next treatment is due. The pill can also monitor heart rates and body temperatures and record whether the patient is receiving enough sleep or exercise.
The system has been tested in many therapeutic areas including tuberculosis, mental health, heart failure, hypertension, and diabetes. The technology is currently under development with Proteus Digital Health.
Branded under the name Helius, it’s designed to
Optimize a patient’s care by providing insight into medication-taking patterns
Help patients manage the transition home
Empower patients to manage daily care and stay connected with friends and family
5. Mobile Games
Apps including HealthPrize and Pillboxie transform adherence into games (with prizes).
As an example, HealthPrize collects compliance data from patients every day and then rewards them for adherence. Patients can choose to report progress through text messages, email, the HealthPrize dashboard, or the HealthPrize mobile platform. The company double-checks accuracy by verifying patient refills.
Patients who take their medicines can earn loyalty points, participate in weekly sweepstakes, or engage in monthly competitions. The company emphasizes that the platform’s core benefit is psychological, with medications feeling less like a chore and more like an interactive game.
As a Forbes article points out, however, HealthPrize has been slow to build a customer base (which will consist of pharmaceutical companies). The company expects to close two to four customers by the end of 2013.
It’s an understatement to say that consumers love mobile games, but is it realistic to expect app developers to make health fun?
You Pick #6
What new technologies have you come across in medication adherence? Which do you expect to improve patient outcomes? Share your perspectives in the comments section of this article below.