The term non-adherence is presently preferred over non-compliance when referring to medication use, as the latter has traditionally implied only willful behavior in medical jargon. Here are statistics from Dr. Lars Osterberg, a noted authority on the subject: 75% of patients have exhibited some type of medication non-adherence. One third of prescriptions are never filled. Non-compliance is responsible for a significant portion of hospitalizations (estimated 33-69%), 125,000 deaths and $290 billion in additional healthcare costs. Medication adherence has many causes. They may include the following: forgetfulness, skepticism about the purpose of treatment, perceived lack of effect, instructions for use not clear, real or perceived side effects, complex regimen, physical difficulty with packaging or swallowing, or cost. One study cited in the article found that for every ten-dollar increase in a medication’s co-pay, there was a corresponding 10% increase in non-adherence.
Medication non-adherence is not easy for the everyday healthcare provider or caregiver to evaluate. One usually has to take a patient’s word. The old method of pill counting is not accurate. There are many ways to increase adherence. A Program at the Geisinger Health system in Pennsylvania utilizes case managers to call patients with multiple chronic diseases acting as coaches while navigating patients through various difficulties that may play a role with adherence demonstrated remarkable positive results as well as better outcomes. Other programs such as pharmacist counseling have been beneficial.
While there is no sure way at this time of proving compliance short of a live observer, mHealth technology is ideal for a problem such as medication non-adherence. There are multiple mHealth products on the market, none perfect. However, certainly the mHealth sector has recognized its potential role in solving this huge problem. Here are just a couple of examples: In various studies, text messaging reminders have been shown in studies to improve adherence with medications given for immunosuppressive medications for, asthma, diabetes, atopic dermatitis, glaucoma, HIV, and for vaccinations http://mobileprm.com/blog/wp-content/uploads/2011/09/Mobile-Health-ROI-Studies1.pdf. One example is CareSpeak Communications’ Mobile Medication Manager is a two-way text system, with a closed loop to the physician and caregiver. GlowCaps™ is a system that consists of a bottle cap which communicates wirelessly with a transmitter. It involves a reminder system for pill doses as well as prescription renewals. The caregiver is messaged as well. An edible microchip technology, developed by Novartis, is embedded in each pill, and sends an email or text message to a caregiver or healthcare provider which is prompted by contact with gastric acid, scheduled to be submitted for FDA review in 2012 (adding a new level to HIPAA compliance?).
Medication non-adherence solutions with mHealth technology are tools that will assist patients in their quest to become more responsible for their own healthcare. Patients DO want to be more involved but lack the support (in all regards) and tools. My blog tomorrow will address barriers to patient engagement and suggestions for their elimination.
mHealth tracking of medication adherence may afford extremely accurate data which may also be applied to clinical drug trials, Pharma marketing that is far more accurate than data presently obtained (tied to prescriptions written), post-marketing surveillance of drugs, as well as use in clinical studies of disease. In addition, it can close the loop from an informational perspective, with adherence data going directly to the patient’s electronic health record, and insurer. Insurers may then be able to provide premium variability based on medication adherence, thereby providing adherence incentives for patients.
A review article by Dr. Osterberg: http://www.nejm.org/doi/full/10.1056/NEJMra050100 (subscription required)
An excellent review of non-adherence research in the elderly is found at: http://www.dhcs.ca.gov/services/ltc/Documents/Medication%20Noncompliance%20Research%20-%20Highlighted%20Studies%20B.pdf
The entire AMA News article may be found at: http://www.ama-assn.org/amednews/2011/10/03/prsa1003.htm