A shocking 50% of patients in developed countries do not take their medications as prescribed.
In the US, USD$213 billion or almost 10% of the total annual healthcare spend could be saved if medicines were taken as prescribed.
While we often look to the consequences of medication mismanagement in terms of the financial cost, medication nonadherence has a vast social cost too. The problem is only likely to get worse with the growing chronic disease epidemic, and nonadherence being a major contributor in patient morbidity. Yet measuring medication adherence is difficult and burdensome. Clinicians are time-poor, and traditional methods such as patient interviews, questionnaires, pill counts, direct observation, direct sampling of serum or urine drug levels, or bio-markers are all time-consuming, expensive, and impracticable.
Technology is the great enabler. Clinicians can use it to find gaps in therapy by using readily available data from dispensing transactions and insurance claims. Software systems can present this information in a timeline view, supporting early interventions. And when combined with other clinical information, software systems can use analytics to identify cohorts of at-risk patients.
A single up-to-date list of the patient’s current medications, shared by the clinician, the patient and their carer, allows everyone to have the same unambiguous view of medication adherence targets. Patients can view their medications on their smartphone, and receive reminders when doses are due. Medication event monitoring systems or ‘smart pill bottles’ can be used to inform the clinician the exact time when a patient opened their medication bottle, and the dose that was removed (by weight).
Ingestible sensor-enabled medications or ‘smart pills’ are also an emerging FDA approved trend. Each pill contains a tiny sensor made from digestible food-based products, and is activated as the pill dissolves in the stomach. Once activated, the sensor communicates with a patch on the patient’s skin, then sends that information to a smartphone app, to report precise information on medication adherence – more reliably than patient self-reporting.
Another way to effectively and efficiently deliver medication to the patient is through an implantable drug delivery device. Researchers at MIT are developing an implantable device which contains tiny reservoirs of medication that can be released under electronic control from a microchip. Imagine a future where this technology is coupled with embedded sensors to measure a patient’s blood glucose level in real-time, and automatically release the appropriate insulin dose, working in a continuous feedback loop. This could be the end of self-injections, hypoglycemic episodes, and reduce the morbidity associated with poor diabetes control.
New technology will drive forward medication adherence, and reduce inefficiencies in our healthcare systems. Combining these technologies with readily available software systems where the clinician, in hospital or in the community, can curate, reconcile, review and modify medications, while also generating prescriptions, will go a long way to reducing medication mismanagement and supporting effective and safe healthcare delivery.
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