Can technology address medication adherence?

By Brian Dolan
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Brian Dolan, Editor, MobiHealthNewsIt's a widely known statistic that between one-third and one-half of patients in the U.S. do not take their medications as instructed, which leads to poorer health, more frequent hospitalization, a higher risk of death and up to $290 billion each year in increased medical costs. Stacked against that figure, Novartis' recent $24 million investment in intelligent medicine / medication adherence startup Proteus Biomedical is a pittance. Given the $290 billion in increased medical costs, Proteus' prediction that its technology has a $100 billion market opportunity appears -- almost -- a bit low.

What is perhaps less widely known is that just last April, Novartis CEO Dan Vasella had this to say about adherence monitors: Internet programs that provide feedback loops to patients, instruments that can measure biometrics and transmit the data to caregivers, and new pill bottles that can remind you (by text message or blinking lights) to take your medications are not enough, Vasella told an audience at a health IT conference.

“These solutions are all fine and good, but I do not believe these technical approaches will solve the equation,” Vasella said. “People are not just machines. People are human beings with social, biological and psychological aspects that need to be addressed” if these solutions are to be effective.

Vasella is right, of course. Poor patient medication adherence includes not taking the medication on time, in the proper doses, or at all. Reasons for non-adherence include everything from unpleasant side effects, confusion, and forgetfulness to language barriers or feeling too well to need the medication.

Show me a text message that can convince a patient that they are, in fact, not "feeling too well to need the medication."

So, can physicians work with patients to increase adherence? A recent study soon to be published in the Journal of Acquired Immune Deficiency Syndromes, found that providing clinicians with more data on their HIV+ patients’ antiretroviral (ARV) adherence does not ultimately equal increased adherence. The study found that collecting data on adherence and providing it to clinicians was not enough to help clinicians work with patients to improve their adherence. Or, it's not the data, it's how you use it. The researchers suggested that clinicians planning to use adherence monitoring services receive training on medication adherence counseling techniques.

Perhaps the key is not the text message, but who the message is from. Proteus Biomedical, RememberItNow, Medic8's Personal Caregiver app and others plan to keep caregivers, friends and family members in the loop and enable them to know when a user has strayed from their medication regimen -- with the user's permission, of course.

Until clinicians take their medication adherence counseling lessons, those closest to us might be in the best position to provide some of the missing aspects of medication adherence that Vasella noted many technology solutions are unable to address. Either that, or there's more embedded in Proteus Biomedical's intelligent pills than the freshly cash-infused startup is letting on.