Adherence tools aid in good habits
Make medications a part of patient’s lifestyle
Education is important in terms of understanding a disease and understanding the medication regimen used for treatment, says Janice Wohltmann, MBA, vice president and general manager of the Menlo Park, CA-based firm Aprex.
For example, without education, some people might follow their physician’s instructions for taking medication twice a day by taking two pills in the morning.
The American Hospital Association (AHA) estimates that up to 59% of people on five or more medications are in noncompliance. The elderly are even more likely to have problems taking their medications. Compliance problems occur at one time or another in over 86% of multiple medication users over the age of 65.
Noncompliance is costly, too. Medication noncompliance results in 10% of all hospital admissions, according to the Chicago-based AHA.
"Even when patients have lots of education about their disease and are motivated, there is still something else they need. That’s help initially to get on a routine of taking their medication regularly," says Wohltmann.
Compliance info downloaded by modem
Several companies have developed products to help patients form the habit of taking their medications correctly and on time. Aprex markets the SmartCap, a computerized prescription bottle cap that beeps when the patient needs to take pills and displays how many hours have passed since the last dosage and how many pills were taken that day.
Most importantly, every time the patient opens the bottle, the time and date are recorded on a microprocessor. A modem at the physician’s office is used to download that information at the patient’s next visit to determine if the patient is taking the medication correctly. (For more information on the SmartCap and all other devices mentioned in this article, see resource list, above right.)
A more intensive program using the SmartCap monitors patients daily from their home. It is designed for the 5% of the patients who account for 40% of the health care bills, says Wohltmann. Patients enrolled in this program are interviewed about their lifestyle to design a workable medication schedule. "What we are doing is integrating medication-taking into the patient’s lifestyle, and we are also making sure they take the medicine according to the doctor’s prescription," explains Wohltmann.
Before going to bed each night, the patient places the SmartCap on a bedside modem that is plugged into the telephone. The modem transmits information to the Aprex office during the night. The next morning, staff nurses review the information and call those patients who are struggling with their medication regimen.
Aprex’s medication monitoring system is paid for in a variety of ways, including managed care plans and employers. Any medical organization that holds the financial risk for the patient will offer the SmartCap, says Wohltmann.
Houston-based MedPrompt distributes alpha numeric pagers through pharmacies. When patients enroll in the program, they receive a page when it is time to take their medication. A message displayed on the pager tells the patient which medication to take, the dosage, and any special instructions, such as "take with food."
The subscriber supplies the prescription, but it is verified through the pharmacist and primary care physician, says Ron Moran, MBA, chief executive officer of MedPrompt.
"We have a physician prescribing form. If the physician prescribes MedPrompt, we have a unit of our business that contacts the patient’s insurer for reimbursement," says Moran.
The target subscriber is a patient over 50 who is still active and somewhat accepting of technology. "Our service is for those people who are trying their best to stay compliant, but forgetfulness is a factor," says Moran.
A third device on the market to help patients stay compliant is Medicine-On-Time, a pill dispenser on a calendar-like card. A pharmacy licensed to use the device sorts, seals, and labels up to six tablets in a dosage bubble on the card.
Each dosage pocket holds all the prescribed medications to be given at a specific time. The card is designed to reduce the stress of having to carry several prescription bottles and remember when to take each medication.
"There are all different ages on these. We had one lady who was being admitted to the hospital at least once a month, and when we put her on the system, she remained out of the hospital for several years," says Debbie Hostetter, pharmacy technician at Bierer’s Pharmacy in Lexington, VA.
Sources
For more information about the devices mentioned in this article, contact:
• Medicine-On-Time — Cost varies for prescriptions sealed in calendar format instead of being filled in prescription vials. Bierer’s Pharmacy, 146 S. Main St., Lexington, VA 24450. Telephone: (800) 552-6779. Fax: (540) 463-3111.
• MedPrompt — Subscriber service is just $32.95 per month with a one-time activation fee of $24.95. MedPrompt, 15814 Champion Forest Drive, Spring, TX 77379. Telephone: (800) 321-7455. Web site: www.medprompt.com.
• SmartCap — The most expensive program is $69 a month with a $250 patient enrollment. Aprex, 1430 O’Brien Drive, Menlo Park, CA 94026. Telephone: (800) 524-6833 or (650) 614-4100. Fax: (650) 614-4110. Web site: http://www.aprex.com.
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