Technology to Improve Patients' Adherence to Medication

I will like to share with you as promised, a technology based initiative that I believe will help improve patient adherence. This program will involve a combination of periodic text messages or e-mails informing patients of the time to take their medication coupled with an alarm fitted on the medication packet that can only be stopped after the patient takes the pill.

Description: the pills will be in an electronic container that will beep like an alarm clock at the time the drug is due to be taken. The alarm only stops when the pill is removed. At the same time, a text message or email will be sent daily to remind the patient. For multiple pills, a computer program can be used.

The initiative has two potential disadvantages: one is that the patient can develop alert fatigue, that is, gets “numbed” to the alerts and might develop an aversion to the system. This can only be solved by a patient education program which must run concurrently. The other is that the system does not actually tell if the patient takes the medication, it only tells if the pill was removed.

Options: The patient will be placed in the program by default but can only opt-out if the physician decides that the patient is not at risk of default, evidenced by writing a letter of undertaking on behalf of the patient.

The mechanism involves active choice by the patient. The patient can only opt out after showing a record of adherence for a period of time, say 3 months after which the doctor can vouch for him/her.

Consequences of default were described by Martin et al. (2005) and include development of worse symptoms, progression of disease to more fatal stages, higher cost of treatment, increased risk of infecting others, time wasting seeking treatment, inefficiency of health systems etc

The program does not preserve the choice of the patient to a large extent. However, with the concurrent patient education program, the patient can be made to understand that the risk of default are too great and that if he complies, he does not have to get an alarm ring and he can be out of the program after 3 months if he complies. The program would be cost effective in that it would save the health system from bearing the cost burden of non-adherence

Reference

Leslie R Martin, Summer L Williams, Kelly B Haskard  and M Robin DiMatteo (2005). The challenge of patient adherence; Journal of Clinical Risk Management, September; 1(3): 189–199.