This is the third article in a series about problems people have taking their medication. The previous article categorized various ways that information technology can help. This article looks at special conditions that weren’t covered in previous articles.
Interventions Must Be Tailored
Reminders lie at the core of many IT solutions to medication adherence. But a mechanistic delivery of generic messages with no particular appeal to a patient’s needs and values will usually be a waste. As Bryan Hill, VP of digital health and innovation at Cognizant, says, “Nudge, but don’t nag.”
I am personally annoyed by the messages my pharmacy and insurance company send me to remind me to order my medication. These messages arrive when a couple months of my current prescriptions remain, so they’re asking me to get medication that will age before I take it. More pointedly, I’ve been taking some of these drugs for more than 20 years and I have never missed a renewal, so you think the insurer would notice and let me alone.
Many of my correspondents emphasized that the failure to take medication is part of a larger Gestalt, or the patient’s lifestyle and culture. We must make sure the medication fits into the lifestyle and culture, because the patient is unlikely to change them. The richness and complexity of these factors go far beyond the social determinants of health that are currently captured.
A sophisticated extension of messaging, adapted to patient needs, was suggested by Rich Steinle, CEO of Carium. A depressed person often has trouble taking action, including the action of consuming the medicine that might help that depression. Carium can query a patient to detect their mood, such as depression and anxiety, and gain insight into actions they are taking to improve their mood and general health. Answers to these queries can trigger personalized education, to-dos, and coaching prompts to encourage appropriate next actions.
Carium also allows a patient, at the push of a button, enter a live video chat with the provider where the patient can upload a picture of a pill to make sure it’s the right one, or take the medicine while the caregiver watches.
Hospital Discharge: The Moment Most Fraught With Risk
A breakdown in medication adherence often takes place upon release from a hospital. Dr. Mitzie Meyers, nursing professor at the Pacific College of Health and Science, pointed out that many patients enter the hospital in a crisis. Because payers want them discharged as soon as possible, they’re tired and might still even be in pain while the staff is trying to educate them about the medications they need. The patient might be angry that they have reduced functioning and that they need a new medication.
According to Dr. Bethany Doran, founder and CEO of Enabled Healthcare, a patient might even leave the hospital with duplicates of their medication, which leads to the risk of overdose. Her service supports patients with any intervention they need, whether just a tablet for education and reminders, or a home visit.
Rich Steinle, CEO of Carium, pointed out that medications often change, either because the patient has a new condition that needs treatment or simply because the doctor in the hospital preferred a different medicine. The more medications an individual is taking, the higher the risk of those drugs interacting dangerously with each other, causing psychological and physical pain and suffering and decreased patient trust. Carium’s platform tracks medication adherence and coordinates care between doctors, patients, hospitals, and other caregivers.
An immediate reconcilation is needed between the hospital and the PCP. But traditionally, the hospital doesn’t make sure the patient has everything they need, relying on the patient to contact the PCP soon after release. But the patient may still be disabled, exhausted, and confused by the hospital stay. At best, a nurse might follow up with a call. Thus, the hospital should provide the patients with an ample supply of the medication they need at discharge. Meyers calls this a “meds to beds” program.
Making Prescriptions and Drug Adminitration More Efficient
A variety of IT solutions improve the experience for the patient. Dr. Colin Banas, chief medical officer at DrFirst, mentions services that combine multiple pills people need to take in bubble wrap.
The solution doesn’t have involve IT. Dr. Michael Wiener, medical director of strategy and planning at Babylon Health, suggested that payers allow for longer supplies of medications so that patients don’t have to go to the pharmacy as often. Babylon’s partners offer up to a year of contraceptives, for instance.
AristaMD helps doctors connect with specialists in more than 70 specialities and do online consultations. According to Pamela Gould, chief growth officer, this service can improve prescribing by applying the specialist’s expertise. Medicaid now allows specialists to bill for these eConsults.
Steinle suggested that genetics also affect the impact of medication. As doctors get more data about the patient’s DNA, they can order the right statin without having to experiment.
The most intriguing example I found of improving the efficiency of administering medication is the Optejet eyedrop dispensor from Eyenovia (Figure 1). As described in the trade press, it is much more efficient and easier to use than standard bottles for eyedrops.
According to Norbert Lowe, vice president of commercial operations, eyedrops are very common. For instance, glaucoma patients get more than half a million prescriptions in the U.S. He said that normally, adherence to the use of eyedrops falls 30% after one month. Their device can monitor the number of doses and when they were taken.
With this grab-bag of IT solutions, I’ll wrap up this series of articles about medication adherence. I’ll take a sudden turn in the final article of this series, rethinking medication from several angles.
