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Using Technology to Increase Medication Adherence

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Medication Adherence is a pressing issue in the healthcare setting. New advances in technology using mobile apps and smart devices are now changing the way we approach assessing patients medication adherence. However, this shift also allows a new chance to be engaged with patients regarding their medications and offers the opportunity to be more aware of medication related issues.

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Using Technology to Increase Medication Adherence

  1. 1. Timothy Dy Aungst, PharmD
  2. 2. Drugs Don’t Work in Patients Who Don’t Take Them.  –  C. Everett Koop, M.D.
  3. 3. Breaking Down Medication Adherence Reasons for NonAdherence Self Discontinuation of Medication – Dose Adjustments – Cognitive Decline – Concerns on SE/ADRs – Fear of Addition – Cost – Trust b/n Patient and Provider – Regimen Complexity – Psychological Status – Over- Utilization of Medications – Health Literacy – PolyPharmacy – Unclear Instructions – Multiple Providers – Medication Reconciliation – Med Errors – Social Stigma – Failure To Communicate – Many More. Traditional Means of Assessing Adherence Categorizing NonAdherence 1 2 3 4 5 Socio/Economic Health System Condition Related Therapy Related Patient Related Pill Counts – Surveys – Blood Tests – Measurement of Physiologic Markers – Blood Markers – Pill Counts – Medication Refills – Clinical Response – Patient Diaries Osterberg & Blashke (2005)
  4. 4. New Forms of Medication Adherence Interventions Smart Pill Bottles Mobile Apps Ingestible Pill Sensors Multi-Dose Delivery The pill bottle has been upgraded to alert patients when to take their medications and let providers know when the medications have been utilized. Leveraging the smartphone for medication reminders has never been easier due to the fact most users rarely leave home without it. Same may not be said about the patients drugs though. The MDD system is a relatively old process in pharmacy, but is making a comeback as a specially packaged patient kit through the use of mail- order and the Internet. A new comer to the market, the ingestible pill comes complete with a biosensor that alerts users and providers when a medication is taken and reaches the gastrointestinal tract.
  5. 5. Mobile Apps – Leveraging the Smartphone How many Apps?! Since the rise of the smartphone, there has been a deluge in the number of medical and healthcare related apps on the market… App Features: - Pill Reminders/Alarms - Scheduled Pill Intake - Pharmacy Sync - Data Log - Patient Diary - Record SE/ADR - Cloud Data Sync - Refill Reminders Over  20,000   Medical  Apps!   However, a study by Dayer and Colleagues (2013) identified only 160 apps of interest related to medication adherence. Still, that is a lot. The authors created a criteria for identifying key features to look for in an app for medication adherence, and identified only a small number of apps that would be beneficial. The issue with Mobile Apps Apps are appealing for patients as they allow the user to personally set up their schedule. However, depending on design this can be a cumbersome endeavor. Apps are also a poor form of patient adherence measurement as it is an indirect tool, and will not benefit most providers or researchers Pros: Cons: - Cheap - Easily Accessible - Cross Platform Support - Integration with Personal Pharmacy - Multiple Drug Related References Included - Indirect Measurement - Security Issue - User Dependent - Many Apps Available
  6. 6. Smart Pill Bottles – Rethinking the Amber Vial Example Companies: AdhereTech – GlowCaps - Pharm Assistant – RxAdvance – Kickstarter So What’s So Different? 10 mg Cheaper technology, widespread internet connection and integration of Bluetooth has led to the ability to essentially make any device integrated and ‘Smarter.’ This isn’t your grandparents pill bottle. How Does it Work? The overall idea is that the pill bottle is equipped with sensors that detect when a medication is removed (the cap or a weight sensor), and then sends a message to the app or associated person of interest that the medication has been removed. The assumption I that the patient took it then. Pros: Cons: - Familiar to Patient - Integration with Mobile - Patient Feedback - Possible Integration with Pharmacy - Alerts Providers & Researchers - Setup Complication - Cost - Needs Wireless - Indirect Measurement Beyond the Pill Bottle Companies and Start-ups are exploring creating smart pill boxes and pill trays rather than just the pill bottle. These Smart Stations have other features such call call features and message screens that expand standard capabilities.
  7. 7. Ingestible Pill Sensors – Now That’s Advanced Science Meets Medication Tracking Now this new piece of technology is leveraging the advances made in biosensors. Essentially, as the sensor is ingested, it breaks down in the gastrointestinal tract and sends an alert. Example Companies: Proteus Digital Health - eTect Bio Pros: Cons: - Direct Measurement of Medication Intake - Integration with Mobile - Patient Feedback - Possible Integration with Pharmacy - Alerts Providers & Researchers - Costly - Logistical Preparation - Needs Wireless - Low Widespread Adoption The Setup The patient wears an external sensor attached to the abdomen, that will pick up the alert from the pill breakdown. This is then transferred to an app or provider to alert those involved that the patient has taken their medication. Data includes time of intake and possibly what medication. Two Different Mechanics Currently, a patient must either take a separate sensor, or a capsule that includes the medication inside.
  8. 8. Multi-Dose Delivery - Old Tools in a Digital Age Example Companies: PillPack – Integrated Health Information Systems (IHIS) - Parata – Phillips Medido – Xubex – Independent Pharmacies Pros: Cons: - Mail-Order - Patient Friendly Utilization - Good for chronic disease management - Logistical Setup - No Immediate Changes - Indirect Measurement Sometimes Simplicity is Easiest Multi-Dose Delivery Systems are an old tool to package and dispense medications for patients via strip packaging. Their home has customarily been in Health Systems or Long-Term Care, but they are seeing a resurgence as a possible simplified mechanism to deliver medications to patients. Why Now? A convergence between patients increased use in the mobile market, acceptance of mail-order and online delivery methods (thank you Amazon), refinement of Pharmacy automaton, E-Prescribing, and integration of online customer support have allowed the ability for pharmacies to package and deliver MDD services to patients over a wide area.
  9. 9. Which Intervention Should Patients Use? Smart Pill Bottles Mobile Apps Ingestible Pill Sensors Multi-Dose Delivery Good For: Patients looking for an upgraded bottle that can sync with mobile devices and beep at them. Pill stations offer more services which patient may desire. Bad For: Patients who do not want another piece of technology clogging up their medicine cabinet. Good For: Patients looking for a concise medication reminder platform. Bad For: Patients that need help with medication organization or direct clinical support. Good For: Patients on a stable medication regimen looking for a way to easy way to schedule their meds through the day and like mail-order. Bad For: Patients with rapidly changing disease states. Good For: Patients involved with clinical studies, want immediate feedback on ingestion of medications. Bad For: Patients who don’t like wearing sensors.
  10. 10. Which Intervention is Beneficial for Research? Indirect Assessment Direct Assessment Pros: Potentially easily to integrate into current medical research as similar to current pill bottles used in clinical trials. Pill bottles may also be programmed to remind patient to take their medications for feedback. Pros: Depending on sensor, can directly measure patient ingestion of medication. No reliance on specific medication organization, and may better identify true patient regimen. Cons: Can not directly verify patient did indeed ingest the medication. Set-up and need for patient connection through wireless services. Cons: Patients required to wear external sensor in order to function. Depending on sensor, may require larger overhead of preparation of individual medication. Again, reliance on patient access to services.
  11. 11. My Ideal Combination MDD supplies patient with clear and concise regimen reviewed by providers Ingestible Sensor inserted into Strip Packaging to provide alerts of medication Intake Patient supplied with easily accessible means of taking medications and can give feed back to providers Provider receives alerts on patient medication intake and can identify any issues App platform for patients and providers to communicate through and for patient to identify any new problems w/ therapy
  12. 12. Upcoming Disruptive Developments Wearable Integration Undoubtedly, we will see a number medication reminders on smartphones migrate to wearable devices to provide similar services. Other potential results would include integration with other smart adherent tools identified as well. Gamification Mechanics Motivating patients to be adherent to their medications is an area of interest, especially it if it can increase consumer demand and branding. This includes financial incentives or membership offers for participation in the brands programs. Drug Device Integration New sensors are coming to the market that are meant to partner with medical devices (e.g. Inhalers, EpiPens) and improve functions and make them ‘Smarter’ Financial Rewards Store Points Discounts
  13. 13. Technology Alone Won’t Solve Adherence Technology is Only One Component to Increasing Medication Adherence If patient’s were only forgetting to take their medications, we would have solved the issue of adherence long ago. As mentioned earlier, taking medications can be a complicated endeavor for patients, and quite frankly is a difficult issue to tackle. Using technology may be beneficial for some patients, and needs to be addressed on a case-by- case basis. It is unlikely that any of the prior mentioned tools will address all a patients wants or needs, and that each intervention may only be beneficial for select patients. Engagement and Communication with Patients is Key The beauty of all of this new technology coming to market is that it can really push the paradigm of patient engagement regarding medication use. No longer restrained to office visits, mobile technology has offered the ability to communicate with patients outside of the clinic and in the community setting, where they belong. If technology can help keep them there, and can help bridge the gap between patient and providers and also empower patients, then it should be an option. Expect More Disruption to Come Your Way Medication Adherence is a huge area of interest for multiple parties. Yes patient care is number one and improving quality of life. But lets be frank, its also a money making area depending on how you approach it. So expect new developments from the tech industry, start-ups, and innovators looking to make it big in the realm of healthcare. Because if nothing else, someone needs to take their drugs and someone wants to help them do it.

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