1. Ruth A. Maulucci, Senior Member, IEEE and Daniel Somerville Ruth A. Maulucci is with MOCO, inc., Scituate, MA, 02066 USA. Phone: 781-545-2040; fax: 781-545-8141; email: maulucci@mocoinc.com. Daniel Somerville is with MOCO, inc., Scituate, MA, 02066 USA. Medication Adherence: A Low-Tech Solution To A Low-Tech Problem

2. STARTLING STATISTICS 50% of all patients are non-adherent, regardless of age, gender, ethnicity, or medical condition. Non-adherence results in 125,000 deaths annually. Non-adherence costs the healthcare system over $300 billion annually -- an avoidable medical expense.

3. HIGH-TECH SOLUTIONS Telemedicine Services Alarm Units Automatic Dispensers Smart Phones Electronic Pill Boxes Electronic Monitoring Microelectronic Feedback Intimidating Costly Difficult to use Average Patient Impractical Non inclusive

4. TRADITIONAL METHOD FOR IMPARTING MEDICATION INSTRUCTIONS SET OF LEAFLETS One leaflet for each medication in patient's regimen TMI -- too much information that is not necessary each time the medication is taken Cannot be ordered temporally, so set must be consulted throughout the day to determine if it is time for a medication LABELS & STICKERS ON MEDICATION CONTAINERS Still substantial writing that is not necessary at usage time Directions are obscured, incomplete, and not all in one place Stickers are randomly attached Containers cannot be ordered temporally, so it is still necessary to glance at the containers throughout the day to capture the next event

5. ANNOTATED CHRONOLOGICAL MEDICATION SCHEDULE (ACMS) Software system that incorporates all aspects of all medications in a regimen into a chronological schedule Input: name, dose, and frequency of each medication Output: chronological schedule for the medications together with only the essential directions required at the time of use, one hard copy page for each time a medication must be taken Attributes: optimizes the use of time slots, properly spaces medications, respects specified requirements Inclusive: accommodates any form of medication Algorithm: tried and discarded elaborate algorithms in favor of simple, error proof exhaustive search methods Users: primary care physicians, hospitals for one-time discharge of patients, assisted living facilities, medication adherence services.

6. ACMS INPUT SCREEN

7. ACMS OUTPUT PAGE

9. Hear the true story that inspired this research “Sal” “Marie” The Story of Sal and Marie