Adherence Is Not One-Size Fits All: 6 Beyond The Pill Examples

Earlier this week I posted how close to 50% of us aren’t taking our medication.  How can we fix that?

What’s the best possible outcome and how could we get there?  We’ll never get to 100%.  Some prescriptions don’t need to be filled.  Sometimes you should stop taking a drug due to side effects,  or for other reasons.

But surely we can do better. My Google search for medication non-adherence this morning returned 462,000 results, which arguably implies that quite a few people are interested in doing better than the current 50 to 60%.

You can’t manage what you can’t measure.  Before the advent of smart devices, we had limited ability to measure what happened when patient left the site of care, other than what they self-reported on the next visit, or by making a phone call to the patient.

As the chart below illustrates, if a patient optimistically gets an hour a month with medical staff, over a year that equates to 12/8760, or 0.14% of life time that is potentially measured.

Now, if a device talks to an app that talks to the cloud, you can potentially monitor in real-time.  More effectively, exception reporting can be used to highlight changes that a medical professional needs to know (e.g. signs of imminent heart attack) or would like to know (e.g. Bob has stopped taking his meds).

In the last post, I also also shared an excellent diagram that divided non-adherence into 3 buckets:

1. Not filled
2. Non-execution (not following the regimen)
3. Non-persistence (stopping taking the meds)

Before electronic prescribing took off, we didn’t have a good way to cross-reference the prescriptions written versus those filled  (SureScripts has great stats here, but note that 1.2B eRx is only 30% of 4.0B Rx filled at retail in 2014).  This doesn’t solve why not filled, but does offer the potential to follow up with a patient and ask why not.

There have been a couple of recent announcements of nifty monitoring devices for inhalers that are being used to tackle both non-execution and non-persistence with the FDA’s blessing (if a device is going to remind someone to take a med you’ll want that approval).  NZ-based Adherium announced a partnership with Astra-Zeneca last week.  They cite that their device “has been clinically proven to increase adherence by up to 59% in adults and 180% in children with asthma”.  Wisconsin-based Propeller Health also recently announced FDA clearance for use of their device with a GlaxoSmithKline asthma and COPD inhaler.

When it comes to pills, it’s harder to know if the pill actually went into someone’s mouth.  There is the ingestible sensor from Proteus Digital Health which communicates time taken to a patch on the skin and then to a smartphone app. They announced earlier this month expanded indications from FDA “enabling the device to be used as an aid in the measurement of medication adherence”.

The next best solution with pills is to know the time and number of pills leaving the bottle.  CleverCap is a smart top to a prescription bottle that can handle complicated pill regimens and different pill sizes, reminding patients when to take their meds and how many they need to take, which should help with the non-execution problem.

Yet another approach was presented by Boston’s Partners HealthCare by using a private Facebook page and monthly reminders from clinicians to improve engagement with asthmatic teens.  They reported a jump in engagement from 18% to 79% after 12 months in terms of taking a monitoring test, and subsequently an improvement in scores in that test for that private Facebook group.

Many smart people have been trying to solve the adherence problem for a long time.  There’s unlikely to be a one-size fits all solution.  These examples suggest some of the advances being enabled by new technology.