Struggling with medication adherence: A bitter pill to swallow

Pills in blisters

It sounds so simple to have people take their drugs on time and in the dosages prescribed by their doctors. However, medication non-adherence is a serious problem in this country that is unhealthy, potentially lethal for patients and very costly for our healthcare system. A recent poll of American adults showed that nearly two-thirds of Americans who take prescription medications are non-adherent, either by not taking their medication as prescribed or not at all, which is resulting in increases in ER visits and hospital readmissions. 

Still worse, every 90 minutes a patient dies because of an accidental overdose or missed prescription. And, according to the 2012 Express Scripts Drug Trend Report, the U.S. wastes an estimated $317.4 billion annually on unnecessary medical costs that can be avoided by eliminating medication non-adherence. Not surprisingly, nearly two thirds of physicians in a recent survey said medication adherence is a top health issue in which an mHealth app linked to EHR could make an immediate impact.

One disease that requires absolute medication adherence is tuberculosis, the second-leading cause of infectious disease deaths worldwide that kills more than 1.4 million people every year. TB is curable if patients strictly follow an appropriate antibiotic regimen, which typically requires taking a combination of pills daily for six months. However, inappropriate treatment regimens and poor medication adherence have led to the emergence of drug-resistant strains of TB.

Just last week, the University of California-San Diego and the Verizon Foundation announced a solution called Video Directly Observed Therapy (VDOT) that allows TB patients to video record themselves taking their daily medications on smartphones and send the videos to health departments, which monitor and document each dose of medication remotely. VDOT is currently being used by the San Diego County TB Control Program and health departments in San Francisco and New York City will soon begin using this first-of-its-kind remote treatment-monitoring system nationally.

But, the technology solution doesn't need to be so elaborate as demonstrated by seniors who recently improved their medication adherence with cell phone text reminders. The Front Porch Center for Innovation and Wellbeing, one of Southern California's largest not-for-profit providers of retirement living communities, teamed with New Jersey-based CareSpeak Communications, a mobile communications technology solutions provider, to pilot CareSpeak's mobile health manager technology. 

The project featured customized texting services for medication alerts, diabetes and other chronic disease medication reminders, and medication tracking programs for seniors at Front Porch communities and neighboring senior centers. Of those seniors who participated in the study, 66 percent found that the two-way SMS-based medication reminder service made it easier for them to keep track of their medications.

Similarly, in January, MediSafe Project announced that use of its free app resulted in patients taking their medication on time at a 31 percent higher rate than the World Health Organization's estimated average medication adherence rate of 50 percent. Launched in November 2012, the MediSafe Project is touted as the first mobile "pillbox app" that cloud syncs users' failure to take medication on time to their friends, family and caretakers. And, last month, they announced results that show high self-reported medication adherence rates for patients with Type 2 Diabetes--at least 26 percent higher with the mobile technology than general medication adherence rates for long-term therapies. Another free app, from Mango Health, helps users keep track of medications by entering information about the drugs they take as well as when they should be taken. 

Nevertheless, medication non-adherence has been and continues to be a bitter pill that we swallow as a nation. However, mHealth just might be the solution to this manageable problem that has reached epidemic proportions. The question is whether we as Americans will take the medicine for what ails us. - Greg (@Slabodkin)