Technology and pharmacist impact on medication adherence

mobihealthnews: “According to a recent study by Express Scripts, Americans might be wasting as much as $258 billion annually by not taking their prescribed medications. Missed doses can lead to emergency room visits and doctors’ visits, which could be prevented if medication adherence was improved. The Express Scripts study found that more than half of people who believe they take their medications properly are not, according to a report in USA Today.

A similar study conducted by NEHI found that poor medication adherence results in illnesses and ensuing treatments that cost some $290 billion in unnecessary spending each year, $100 billion of that in avoidable hospitalizations alone.

Two members of Congress recently introduced bills to allow Medicare reimbursement for more patients to sit down with therapists one-on-one and equip patients with pill boxes or text message services that help patients become more adherent, the USA Today report said.

The Toronto University College of Pharmacy conducted a study that found medication therapy saved about $93.78 per patient annually in a study of 23,798 people, USA Today reports.”

Problems with medication adherence are nothing new. A recent study in the March 2011 issue of Academic Emergency Medicine ¹ looked at the impact of poor medication adherence on emergency department visits. According to the article “risk for medication nonadherence due to cost concerns was identified in a quarter of nonemergent urban ED patients in our sample and was more likely to be reported by patients experiencing other economic and psychosocial risks. These findings indicate a need to include discussions about medication affordability and referrals to social services as part of ED discharge planning.”

Several options exist to help curb the impact of the medication adherence problem here in the United States. The use of simple technologies like the GlowCap, the Pill Timer and MedReady can go a long way in improving compliance, as can the use short message services (SMS) (i.e. text messages delivered to mobile phones). While SMS has been shown to be beneficial in several disease states ^2-5, it doesn’t work for everyone.⁶

While technology certainly plays a role in improved medication compliance, it’s important that we don’t forget the human element involved in the process. Pharmacists are linchpins in the medication use system. They can play a significant role in improving the medication use process and reducing healthcare costs through medication therapy management (MTM). MTM has been shown to improve medication compliance and reduce overall healthcare cost.^7-8 While the concept of MTM isn’t new, the approach has received renewed interest in light of the PPMI and via pharmacy organizations like the American Pharmacists Association.

With over $200 billion at stake it shouldn’t be a question of which approach to use (i.e. technology or pharmacist intervention), but rather when do we start. Based on the size of the opportunity, the answer should be now.

References:

1. Mazer M, Bisgaier J, Dailey E, et al. Risk for Cost-related Medication Nonadherence Among Emergency Department Patients. Academic Emergency Medicine. 2011; 18: 267–272.
2. Lester, R., Ritvo., Mills, E., et al. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomized trial. The Lancet. 376:1838-1845.
3. Strandbygaard,U., Francis, ST., Backer, V. A daily SMS reminder increases adherence to asthma treatment: A three-month follow-up study. Respiratory Medicine. 2009; 104:166-171.
4. Hanauer DA, Wentzell K, Laffel N, Laffel LM. Computerized Automated Reminder Diabetes System (CARDS): e-mail and SMS cell phone text messaging reminders to support diabetes. Diabetes Technology & Therapeutics. 2009; 11:99-106.
5. Miloh T, Annuziato R, Arnon R, et al. Improved adherence and outcomes for pediatric liver transplant recipients by using text messaging. Pediatrics. 2009; 124:e844-e580. (free full text PDF)
6. Hou MY, Hurwitz S, Kavanagh E. Using daily text-message reminders to improve adherence with oral contraceptives: A randomized controlled trial. Obstetrics & Gynecology. 2010; 116:633-640.
7. Smith M, Giuliano MR, Starkowski MP. In Connecticut: Improving patient medication management in primary care. Health Affairs. 2011; 30:646-54.
8. Hirsch JD, Gonzales M, Rosenquist A, et al. Antiretroviral therapy adherence, medication use, and health care costs during 3 years of a community pharmacy medication therapy management program for medi-cal beneficiaries with HIV/AIDS. Journal of Managed Care Pharmacy. 2011; 17:213-23.