We have all heard the numbers. Medication nonadherence can cost the healthcare industry billions of dollars ($337 billion in 2013 to be exact, according to Express Scripts). The pharmaceutical industry also loses—$188 billion annually, according to a 2012 Capgemini report. And often the patient loses. Studies have shown that poor adherence:
- Results in 33% to 69% of medication-related hospital admissions (New Engl. J. Med., 2005).
- Leads to a 17% increase in emergency room visits and a 10% rise in hospital stays among patients with diabetes, asthma, or gastric acid disorder ( of the Amer. Med. Ass’n, 2004).
- Causes at least 125,000 deaths a year in the U.S. (Gen Med., 2005).
In other words, when patients don’t take their meds properly, everyone loses. That’s why so many are working to discover ways to help improve adherence. These 12 solutions, from people associated with the healthcare industry as well as outside tech companies, are just some of the new methods available to solve one of healthcare’s biggest problems.
To help counter the New England Healthcare Institute’s reported nearly $300 billion impact of annual medication non-adherence, Cardinal Health unveiled a new medication synchronization program, Cardinal Health MedSync Advantage (http://bit.ly/1pkzGRK). Community pharmacists can help improve medication adherence and patient outcomes while increasing efficiency for the pharmacy through this custom-built online medication synchronization program.
Cardinal Health MedSync Advantage is the newest offering in a comprehensive suite of solutions from Cardinal Health called Reach for the Stars. The online platform was designed by Cardinal Health’s innovation lab, Fuse, which connects technology with healthcare and allows users a say in the development process.
Fuse built the MedSync Advantage web-based solution with direct input from community pharmacists, creating a custom tool that supports easier identification of eligible patients, as well as:
- Integration with pharmacy management systems and daily or monthly reporting.
- Automated synchronization to ensure ease of adding customers.
- Access through a single sign-on with the Cardinal Health customer ordering platform, Order Express.
With Cardinal Health MedSync Advantage, a pharmacy can coordinate a patient’s prescriptions to be picked up on the same day each month. This simplifies the process for patients and caregivers filling multiple prescriptions, and improves patients’ medication adherence by helping to ensure they fill all prescriptions each month. Confirming the number of prescriptions a patient fills each month improves inventory management for the pharmacy and allows more time for the pharmacy staff to focus on patient relationships.
dr Poket’s solution ensures patients take the right drug in the right dosage at the right time—every time. The centralized online and mobile solution is secure, HIPAA compliant, uses HL7, and it fully integrates with PillBox—an electronic pill dispenser. Also, because it streamlines the drug prescription process, it saves time for doctors too. In the end, it virtually eliminates human error during treatment.
Meanwhile, patients get something that is more than just an alarm clock that reminds them to take meds—it’s an advanced drug management and tracking platform that informs them about possible drug interactions and precautions in the simplest possible way. The platform is accessible through a mobile app or any device connected to the Internet.
Recently, the company also developed PillBox, an electronic pill dispenser synchronized with the dr Poket Platform, designed especially for the elderly and people with disabilities. When the time for medicine comes, PillBox notifies the patient about it and serves the right dosage of drug.
The pill dispenser will send light and sound notifications and serve the right dosage of medication at the right time. Additionally, PillBox has braille indicators to help visually impaired individuals find the right container with their meds. Any missed dosage is reported directly to the physician or caregiver, which makes the therapy supervised and effective.
While other apps that improve medical adherence often just send reminders, dr Poket—combined with PillBox—is a complementary meds taking assistant: Informing patients about precautions, interactions, med taking time, and even when drugs supplies are getting low.
While technology is clearly at the heart of future adherence solutions, it’s how we implement digital health that leads to improved treatment adherence. To drive meaningful health outcomes, digital health programs need to understand and address health-related patient behavior.
Led by a global digital health team of product, technologists, and health psychology experts, Atlantis Healthcare is launching a proprietary SelfmanagementKit. This digital toolbox integrates self-management principles with theories of behavior based in Health Psychology. Improved patient engagement is made possible through a robust set of user-experience patterns and a digital health technology platform. SelfmanagementKit makes building tailored patient adherence programs more scalable and cost efficient.
Enabling improved treatment adherence is made possible by addressing key underlying beliefs of an individual’s health-related behavior. Digital health programs enable an incredibly efficient approach to designing individually personalized interventions across each patient population with savings in time and resources.
For more than 20 years, Atlantis Healthcare has applied the discipline of Health Psychology to personalize interventions to the individual in order to drive long-term behavior change. SelfmanagementKit standardizes this approach, leveraging the company’s unique and unparalleled heritage in delivering sustained improvements in treatment adherence.
The Atlantis Healthcare SelfmanagementKit enables pharma to apply decades of peer-reviewed clinical research and tested user experience workflows. Clinical, user-centered design and technology expertise underpins SelfmanagementKit and is key to humanizing digital health to create effective patient support interventions that improve adherence long term.
The new class of wearable, high-volume injectors promise a more convenient, comfortable, and less stressful way of delivering large volume medications—such as the more than 900 biologics in development—to people with serious medical conditions and rare diseases. Providing an option to inject at home or on the go may boost persistence to prescribed therapy.
Enable Injections has developed a simple to use On Body Delivery System (OBDS). Tested in numerous human factors studies with participants of variable cognitive abilities and physical dexterities ranging in age from 7 to 85 years, it is designed to provide the best possible user experience. The friendly, non-threatening look of the device—coupled with no visible needle—resulted in a lower level of pre-injection anxiety as demonstrated in a clinical trial comparing the Enable Injector to two other popular injection methods, syringe and pump device.
Many biologic drugs require refrigeration and need to be warmed to room temperature for 30 minutes to ensure correct dispensing and/or minimized pain. With the Enable OBDS, a standard drug vial or syringe is warmed as it is transferred into the injection device—ready in seconds for patient use. Reconstitution of a lyophilized drug with diluent is also automated.
In the clinical trial, lower pain scores were associated with use of the Enable OBDS due to the advanced delivery mechanism that minimizes pain by slowing infusion in response to back pressure on an individual basis. Users’ perception of the Enable OBDS as an easy-to-use, non-threatening way of receiving therapy with no mobility constraints during treatment, could lead to improved compliance for medication that can be administered through the device.
One of the nation’s costliest health problems can be just as hard for people to see coming as a complex disease or a sudden accident—though it is neither of those. It is the deceptively simple-sounding fact that millions of people don’t take their medications as prescribed.
Nonadherence leads to medical complications, extra tests, emergency room visits, and hospitalizations. Express Scripts research shows it also cost the United States $337 billion in 2013, the most recent year for which figures are available.
Yet when asked whether they thought they would become nonadherent, only about 10% of people who eventually did so were able to predict it would happen. It turns out that advanced analytics can do a much better job of predicting nonadherence.
ScreenRx, Express Scripts’ adherence solution, does this by considering more than 300 factors about the patient, the physician, the disease, and the prescribed therapy. It is up to 94% accurate in predicting nonadherence one year in advance.
And early identification paves the way for successful interventions. Once a likelihood of nonadherence is detected, specialist pharmacists, nurses, and other clinicians at Express Scripts’ 20 condition-specific Therapeutic Resource Centers (TRCs) can reach out.
They talk with patients to determine the problem. Up to 30% of prescriptions are not filled. Even when people do get a medication, they may miss doses, take the wrong dose, stop treatment early, or never start. The most significant reasons include behavioral issues, such as forgetfulness or procrastination, cost issues, and clinical issues, such as side effects.
Getting to the root of nonadherence allows patients, their caregivers, and providers to take steps to avoid it—saving dollars and even saving lives.
Cadient’s strategy for addressing health literacy for patients involves two steps: Design and content strategy. When designing content, the company looks at the words or instructions that can be paired with icons or visual cues (such as the examples above) and alerts as well as complex terms. The strategy for choosing the actual content typically starts by following two approaches: Using plain language and looking at how phrases and the weight of content is blocked in the materials. The less physically dense the copy, the better it can be understood. Finally, patients come with all forms of understanding of their health, so campaigns and materials must always plan for the lowest degree of literacy—typically at a 5th grade reading level.
By simplifying language, using visual cues/illustrations, or incorporating interactive tools, patients will better understand instructions around their medication and condition—ultimately leading to improved levels of compliance. This approach addresses the full spectrum of how people learn. All humans absorb information in one of seven ways: Linguistic, logical, spatial, musical, kinesthetic, interpersonal, and intrapersonal. Digital (e.g., video, quizzes, visual storytelling/infographics, etc.) is the only medium that caters to all of these methods.
Cadient recently unveiled a new way to present important safety information and a fully developed lexicon for a newly discussed disease state. So far, the company is seeing initial success through numbers of downloads as well as anecdotally through patient and stakeholder interactions and feedback.
Triplefin’s behavioral-based patient coaching program complements any adherence strategy with a focused case management approach directed by a Customer Care Center coach. An alternative to nursing administration, this clinical program is unique in that it centers on the understanding of the patient’s level of adherence towards his or her therapy protocol by administering a series of questions relating to their personal habits.
Coaches then create weekly schedules to contact patients who have enrolled in the program and discuss health-related issues. Through regular contact, coaches develop a sustained relationship with their patients, encouraging and motivating them to undertake the behavior changes needed to improve diet and exercise, manage stress, quit smoking, and adhere to prescribed drug regimens—all to improve overall health outcomes and aid in recovery.
The use of behavior-based coaching strategies aims to inform and motivate patients to close the adherence gap by addressing many of the most common barriers patients face when managing chronic healthcare conditions. Meanwhile, from the brand perspective, programs that are able to support successful, sustained use of products in the marketplace are essential to maximizing brand performance.
Silver Mother is a set of carefully designed monitoring programs that adapts to every person’s concerns and lets seniors live a safe and independent life.
You just need to select the programs and routines that are relevant to your loved one’s lifestyle and health needs. Then, attach a tiny sensor to everyday objects. If a routine is not performed, it will be detected and caregivers will be alerted.
For example, seniors only need to attach a sensor on their regular pill box, bottle, or blister pack. Then define a schedule. The sensor will detect the movements of the medicine container. It will record all movements linked to medicine intakes without taking random movements—such as moving the box around—into account. If no movement is detected at the moment the person is supposed to take his/her medicine, the person or/and the caregivers will receive a reminder (phone calls, notification or text message).
Silver Mother is a unique tool for addressing adherence due to:
- Technology that adapts to every person’s needs and routines.
- Sensors that seamlessly blend into the everyday activities of seniors.
- No training required, no button to press, nothing to wear—seniors simply carry on their daily activities like they always did.
- Family members and caregivers can remotely make sure that their loved ones are enjoying a secure and healthy life and receive immediate alerts when a cause for concern is detected.
- All the monitoring programs are free—forever. No monthly subscription or fees are required.
In the ever-expanding digital environment, brand patient engagement begins in the exam room when a treatment is first prescribed. Patient adherence is best initiated with complete knowledge and understanding of the treatment expectations. Research confirms the first barrier to adherence is the patient’s inability to understand and accurately recall what they were told. Clinicians are not great communicators and use jargon that is not well understood by the patient or their caregiver. Research shows that 1 in 3 prescriptions are not filled after patients leave the office, in large part due to poor communications and patient understanding.
Liberate Health is proven in clinical experience trials to improve patient and caregiver understanding. No other digital exam room tool placed in the hands of a clinician combines educational content along with the ability for the clinician to record their instructions and send the recorded interaction, compiled as a video, to a HIPAA compliant patient portal. The patient can review this over and over to improve understanding of the clinician’s instructions.
Liberate provides a brand the ability to ensure a consistent and complete message is delivered to the patient along with the clinician’s implied consent. This is a powerful way for brands to deliver important information to the patient that improves both compliance and health outcomes. Educational information can be placed on the Liberate platform in a variety of formats that include video and infographic education decks.
Liberate has been shown to be the front door to adherence programs, including patient engagement programs, co-pay, and incentive programs that all lead to increased adherence.
e-pill currently markets 53 different electronic medication reminders, such as the popular e-pill MedTime Station, with its most recent offering being the MedTime SAFE.
The e-pill MedTime SAFE—patent pending—was developed to improve adherence for those suffering from addiction. This device caters specifically to those who are either addicted to medication or those taking CII/CIII medication, such as methadone or buprenorphine, in a drug rehabilitation facility. This device administers the right medications in the correct dosage, and at the correct time, while keeping the medication securely locked inside the dispenser.
This dispenser is both tamper-resistant and tamper-proof with four independent locks—making it difficult for patients to break into. The automatic dispenser can be programmed to administer drugs up to six times per day. When it is time for medication to be administered, an alarm will sound and the medicine will rotate into position. Subsequently, the patient simply needs to lift and turn the dispenser upside down in order for medication to fall out of the device. The MedTime SAFE is also portable, which allows the patient to take their medication with them to work, school, or a rehabilitation facility in a secure auto-dispensing pillbox.
While this specific e-pill Electronic Medication Dispenser (EMD) is still new, previous clinical studies have proven that an EMD can save the healthcare system $5,400 per pill dispenser distributed. Having also been used in Swedish clinical testing, it has been confirmed that patients with an EMD device experience organ rejection significantly less than those without an EMD device. Meanwhile, e-pill has partnered with the University of Vermont and the Howard Center on a study that will involve the MedTime SAFE to test treatment methods aimed at helping opioid-dependent patients.
HealthPrize and West Pharmaceutical Services have created a flexible connected health program for West’s injectable delivery systems, which is designed to engage patients and sustain medication adherence.
When the HealthPrize digital platform—which utilizes gaming dynamics, behavioral economics, and consumer-marketing strategies to entice patients—is linked to a West injectable delivery system, it engages patients, monitors adherence, educates, and rewards patients for usage.
Patients on medications administered via West delivery systems are already operating within the inherently difficult context of self-injection. By integrating the HealthPrize platform, the goal is to offer products that are not only easy to use, but appealing enough for patients to want to use and feel good about doing so. By normalizing the patient experience into a mobile or online interaction, the program delivers a psychological and emotional boost, making the experience more positive and replacing the “patient” stigma, which in itself can be an adherence barrier.
More than traditional reminder programs, the combined digital health platform offers two-way interaction and true connectivity to gather data. That data can then be fed back to pharmaceutical clients and healthcare payers to analyze relationships between product adherence and health outcomes, cost-benefit equations, and return on investment. While the program helps participants adhere to their injectable medication, it is also gathering data to address the adherence issue as a whole.
The HealthPrize-West collaboration is currently in development (two of four phases are completed). However, additional HealthPrize programs are currently providing data that demonstrate improvement in adherence. In the case of one branded medication, pre- and post-enrollment measurement of gap days—days late to refill—showed a 124% reduction after engaging in a HealthPrize program.
Similar to how a child practices piano more frequently before a lesson, patients’ adherence to medications usually increases right before follow-up visits.1 This phenomenon, dubbed “white coat compliance,” indicates a need for more frequent check-ins. Lack of patient accountability is a major problem, but increasing doctor’s visits to address the issue is not the most feasible or cost-effective solution.
Frequent follow-ups and accountability can increase adherence by 15%.1,2 Overall adherence in acne patients receiving a weekly Internet-based survey ranged from 58% to 100% versus 4% to 80% in the control group.3
Causa Research’s medication experience reporting system (MERIT) sends automated, weekly emails asking patients to report how they are doing on a new medication—creating accountability that encourages better medication use. The MERIT system is simple to initiate, collecting only the patient’s name, contact information (email address), medication prescribed, and frequency of messages (weekly or monthly). The emails, sent on the prescribing physician’s behalf, would ask the patients a few questions to get feedback on how well the treatment prescribed is working. Pharmaceutical marketers can encourage physicians to use the system or physicians can use it directly with patients.
Traditional electronic “reminders” have not been very successful since they don’t utilize “white coat compliance” via survey feedback.3 Causa’s automated Internet-based system of two-way communication is a cost-effective, highly scalable, practical, and easily implemented means to improve adherence and supplants the traditional simple reminder.
1. Feldman SR, Camacho FT, Krejci-Manwaring J, Carroll CL, Balkrishnan R. “Adherence to Topical Therapy Increases Around the Time of Office Visits.” J Am Acad Dermatol 2007 Jul;57(1):81-3.
2. Sagransky MJ, Yentzer BA, Williams LL, Clark AR, Taylor SL, Feldman SR. “A Randomized Controlled Pilot Study of the Effects of an Extra Office Visit on Adherence and Outcomes in Atopic Dermatitis.” Arch Dermatol 2010 Dec;146(12):1428-30.
3. Yentzer BA, Wood AA, Sagransky MJ, O’Neill JL, Clark AR, Williams LL, et al. “An Internet-based Survey and Improvement of Acne Treatment Outcomes.” Arch Dermatol 2011 Oct;147(10):1223-4.
To help healthcare organizations improve adherence, Health Advocate’s Specialized Product Support (SPS) program combines years of customer service experience with proven communications strategies. This program supports and educates patients through a variety of channels, helping to increase adherence, improve health outcomes, and reduce costs. Program offerings include outreach therapy compliance, technical product support, DTC support, loyalty programs, care coordination, clinical education, regulatory compliance, telenursing, and more.
The patient experience is central to the SPS program, which personalizes outreach according to the patient’s preferences, clinical profile, and risk factors. By combining state-of-the-art technology, actionable information from data analytics, and unlimited support from a Personal Health Advocate, patients have access to valuable resources to address potential barriers. Data show that the personal touch of a live agent improves both patient engagement and adherence.
Health Advocate’s SPS program identifies the appropriate dedicated associates, from customer care to RN clinical support, for each program, and connects patients with a Personal Health Advocate to help with related health issues and navigate the complex healthcare system. This extra level of ongoing support enables patients to address and resolve potential challenges to adherence, including clinical questions, technical support, and insurance concerns. Additionally, the SPS program is flexible and can be customized to meet the needs of each organization, product, and patient population.
During one recent campaign, only 4.25% of patients in a control group with no contact from the SPS program filled their prescriptions. However, among patients who had interacted with clinical care associates, 19.12% of patients filled their prescriptions—a 450% increase over the control group. The SPS program has also earned a CSAT Customer Satisfaction rate of 97%.