“Drugs don’t work in patients who don’t take them.”–C. Everett Koop, MD (former U.S. Surgeon General)
Only 1 in 2 patients take their prescribed medications correctly and on time, according to the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). Poor medication adherence is costing the U.S. healthcare system between $100 billion and $290 billion annually in terms of clinical complications, costly readmissions and rising death rates.
Companies and startups are trying to help boost compliance through a number of digital health tools.
The ubiquity, convenience and cost-effectiveness of mobile phones make them attractive tools to promote adherence among patients. There are scores of mHealth apps available to keep track of medications.
One example is MediSafe, winner of this year’s Health 2.0 Startup Champions and an iOS and Android mobile app that sends medication alerts to patients and their caregivers or family members. It claims its users have an 86% medication adherence rate, much higher than the 50% rate for the average patient.
The CardioSmart Med Reminder is a free app that allows patients to keep track of medications, customize alerts, and share medication lists with doctors and pharmacists.
Among 160 smartphone medication adherence apps tested by the Journal of the American Pharmacists Association, MyMedSchedule, RxmindMe and MyMeds were rated highest due to their solid medication reminder features along with enhanced levels of functionality.
Simpler, SMS-based programs seem to be similarly effective. A study of hypertensive patients who used text-based reminders improved their medication adherence rate by 43%.
The Txt4Health initiative is a free, interactive, text-messaging based tool for diabetic patients that assesses risk and offers information, goal tracking, and reminders.
Companies such as Mango Health and Health Prize reward “incentives” and “prizes” to patients who adhere to their prescription drug regimens. Users accumulate points by sticking to their medication schedules, answering quizzes and refilling their prescriptions. Points are exchanged for shopping gift cards, discounts and other rewards.
Electronic Health Records (EHR)
Under the Medicare and Medicaid EHR Incentive Program, CMS has set objectives to improve medication adherence, including providing electronic access to patients to their health data (e.g. medication lists, drug formulary) and electronic prescribing for providers.
According to the ONC Issue Brief (National Progress Report on E-prescribing and Interoperable Health Care), e-prescribing alone “increases medication first fill adherence by 10 percent with the potential to save $140 - $240 billion over the next 10 years.”
The brief further describes that with “meaningful use,” adherence can be enhanced through:
- “Generating and transmitting electronic prescriptions
- Exchanging key clinical information among providers
- Providing patients with electronic access to their health information (including medication lists)
- Enabling automated clinical decision support
- Implementing drug formulary checks”
Eric Bushlow writes in Advisory.com that patient portals are effective for encouraging medication adherence because they provide:
- “Web-based access, allowing patients to view information from home
- Lists of current medications and associated medication-specific information
- Ability to share medication information with relevant providers
- Ability to request refills, schedule physician appointments, communicate with care team
- Risk-modification behavior coaching
- Access to lab results and diagnostics to share with providers”
Advanced Storage Devices
Startups like AdhereTech are making “smart” pill bottles that alert patients using built-in lights and chimes. They also send automated text messages when a dose is missed.
Proteus Digital Health makes the FDA-approved Helius edible sensor that detects ingestion events and transmits to a skin patch a digital code that contains information such as the type of medication, amount of dosage and the time of ingestion.
A recent trial demonstrated that the sensors were able to detect ingestion 99.1% of the time and were able to correctly identify the type and dose of the drug taken 100% of the time.
Companies like RxAnte are using predictive analytics to identify non-compliant patients. It says its platform can predict medication use at the patient level, prioritize and target the most cost-effective intervention, and monitor medication adherence programs.
Analytics startup AllazoHealth says in a survey that 60 percent of managed care organizations are planning on using predictive analytics in their medication adherence programs.
Older interventions remain effective in supporting adherence as well. As Karen Golden-Russell says in a HIMSS article, IVR (Interactive Voice Response) is “a technology that seems low-tech but that can have significant impact on medication adherence according to a number of published studies. The technology automates pre-recorded phone calls to remind patients to fill or refill their prescriptions.”
Medication adherence issues will continue to play a key role in healthcare costs as consumers live longer. According to the WHO and the CDC, there will be at least 157 million Americans with at least one chronic condition by 2020, and most will struggle with medication adherence. Digital health offers useful tools for providers, patients and caregivers to help address this important challenge.