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7 roles mHealth can play in boosting medication adherence.
Smartphones could be the future of medication adherence.
Drug non-adherence is a silent killer. Patients failing to properly follow their prescriptions account for millions of easily preventable deaths and $700 billion dollars annually in avoidable healthcare costs. More than half of doctor visits and hospital readmissions can be attributed to non-adherence as a result of complications that could have been prevented. With only half of patients adhering, the rest present a serious problem for global health — but also an opportunity for drastic improvement.
There is only one way to increase drug adherence: Get patients to take their drugs. On paper, this is a simple task, but the reasons for non-adherence are complex and delicate, and they must be approached with compassion. If we want to get more patients to adhere, we must understand why patients do not take their drugs.
The most common reason for non-adherence is simply forgetfulness. Our busy lives often disrupt routines, and quick tasks like taking a pill are easy to forget when running out of the door after oversleeping or a last-minute change in plans. The same goes for filling and refilling prescriptions. Rain-checking a trip to the pharmacy after a hectic day often turns from tomorrow into two days and then a week. We have to find simple ways to help patients stay vigilant and maintain their routines. Drugs require consistent levels in our bodies to be effective, especially when managing chronic diseases, and lapses in doses can render drugs useless.
Medications are complex, and every patient has their own level of health literacy. For many patients, especially those with low health literacy, following a new prescription requires a lot of trust and can induce a lot of fear.
If a patient does not understand the benefits of a medication, fear of adverse effects may cause them to not take the drug. Other patients worry about becoming dependent on their drugs. Still others are suspicious of ulterior motives by healthcare providers, worrying that medications, especially new ones, are being prescribed on the basis of marketing campaigns rather than health benefits.
Complex regimens contribute to the fear and confusion surrounding medications. Taking a single pill once a day is simple enough, but many patients feel overwhelmed as they struggle to manage many medications, all with their own dosage frequencies and procedures.
Medications can take weeks, if not months, to work, and many patients give up on medications if improvement rates lag behind their expectations. Preventive medicines can be even more difficult to encourage patients to maintain because in the best-case scenario, the patient feels no effects at all. This causes some patients to incorrectly believe their prescription is unnecessary because they feel well. All of these factors have to be combated by establishing trust between providers and patients by providing digestible, accessible information and open communication channels.
In countries without nationalized healthcare systems, many patients have to choose between filling a prescription and paying for food or rent. All are vital to their well-being and cannot be ignored, but when faced with the choice between being sick or hungry and homeless, drugs are often the first to go.
Mobility challenges are another concrete barrier to adherence. If a patient’s physical limitations make filling their prescription more difficult, they are less likely to adhere. While insurance issues must be approached on a system-by-system basis, mobility barriers can be hurdled by establishing care networks that link providers, patients, family and friends.
The aforementioned categories can further be broken down into two groups based on psychological motivations for non-adherence. Intentional non-adherence occurs when a patient consciously and deliberately defies a treatment plan, like quitting a medication or modifying treatments. If a symptom is no longer plaguing a patient, they can be tempted to discontinue treatment, believing because they are no longer suffering, the issue has been resolved. This thought process can lead to unexpected, acute medical emergencies, as their afflictions are not continuing to be managed.
Modifying treatment plans presents similar issues. Patients may cut pills in half or decrease dosage frequency to save on drug costs or because they believe a weaker dose will be enough for their case. Many drugs are rendered useless by these processes, as they do not allow patients to maintain enough medication in their system to provide any effect at all.
Unintentional non-adherence is when a patient believes they are properly adhering but are actually making critical mistakes that compromise their treatment, forgetfulness being the most common. Other forms of unintentional non-adherence can come from failing to properly follow medication instructions. A patient may be taking their ACE inhibitor on time, but if they are still eating bananas, the drug is ineffective, and they are not adherent to their treatment plan.
Because reasons for non-adherence are so diverse, a multifaceted approach must be deployed to get more patients to follow their prescriptions. Any effective attempt must provide comprehensive and simple information about treatment, instill motivation to follow a treatment plan and offer a tangible strategy. Notice that ailments were not mentioned as part of this plan, instead abiding by the philosophy of patient-centered care, where the focus shifts from ailments to those suffering from them.
Understanding the pillars of patient-centered care is key to applying it to drug adherence.
Such approaches have been proven to increase adherence by empowering patients to take care into their own hands and establishing trust based on understanding and collaboration. However, because there are so many facets and providers are caring for so many patients, it can be nearly impossible to provide patient-centered through traditional methods. But you may be holding the solution in your hands (or pocket) right now.
Smartphones offer an inexpensive and easy way to provide a large part of this adherence network. While the effort must be consciously made from the doctor’s office to the pharmacy to the home, phones could help facilitate and unify the process.
Every patient has their own level of health literacy, which is why starting with the most basic explanations of treatments and medications is paramount. This is the first opportunity to establish trust and encourage the patient to feel like they are vital to their own health. Medical jargon and teach-backs can confuse patients and induce stress, as the patient may not comprehend the information but wants to refrain from looking foolish. A lot is thrown at patients during appointments, and remembering it all can be overwhelming.
The Cellphone’s Role: A text/phone app providing treatment summaries and medication information allows patients to have easy access to any information they may forget after a doctor appointment. This way, the patient is not forced to remember every little detail or keep track of slips of paper outlining instructions. Everything is conveniently on the phone.
Managing one prescription can be difficult but managing several can be impossible. Dosage frequencies vary between medications. Specifications require drugs to be taken under certain conditions or at certain times of the day. It’s imperative that care regimen instructions are as simplified as possible. Doctors must optimize treatments for effectiveness while keeping convenience in mind.
The Cellphone’s Role: Text notifications remind patients when it is time to take a pill. The patient then confirms they were adherent, empowering the patient to engage in the treatment process and allowing doctors to confirm adherence. In-app instructions eliminate the need for memorization and disorganized paper trails.
For patient-centered care to work, patients need to be self-motivated. The key to fostering self-motivation is ensuring that the patient feels heard and that they are making a collaborative effort to be healthy. External incentives, like making the world a better place or helping others fighting the same diseases, also increase motivation.
The Cellphone’s Role: Using the phone, a patient can instantaneously voice concerns to the provider, who can answer questions and encourage patients, telling them to keep it up or to try to do better. Providers can incentivize adherence by donating to charity every time a dosage has been confirmed, allowing the patients to help others while they help themselves.
Establishing an extended care network of non-medical professionals, like family and friends, is also essential in maintaining moral and providing multiple support groups and safety nets for the patient.
The Cellphone’s Role: A central phone app allows for a unified communication network between providers, patients, family and friends. The app can automatically send alerts out to anyone in the network if the patient fails to adhere. A central platform helps keep everyone involved with treatment on the same page and encourages communication and coordination.
Patient-centered care is all about focusing on a patient’s individual needs. Treatment plans have to be dynamic. If a patient is struggling to adhere, we need to know why and how to best improve results.
The Cellphone’s Role: By consulting data collected by the app, providers can better troubleshoot treatment plans and work with the patient to increase adherence. Combining such data with sets collected by smartwatches and other monitoring devices could give revolutionary insights into patients’ unique struggles and how to overcome them.
Technologies are too often heralded as quick fixes to complex problems. While tech provides us with powerful new tools, we would be delusional to believe they provide comprehensive solutions to problems like adherence. The greatest downfalls of tech solutions are often the impersonal nature of the user experience and one-size-fits-all approaches.
The Cellphone’s Role: The challenge in creating a cellphone-based healthcare ecosystem is making sure human interaction is not replaced by impersonal interfaces. Users must be engaged by personalized services and human-backed interactions. An app-based system has the power to unify and tackle adherence cheaply, as well as compile data on a unprecedented scale, which could streamline all aspects of healthcare. We must not squander this potential by discouraging users with isolating experiences.
Patient-centered care combines a number of approaches to optimize patient outcomes. Education, self-management, motivation, practical application and tailored treatment all work to improve outcomes and save money.
The Cellphone’s Role: Mobile phones alone will not solve drug adherence but could offer a unifying patient-centric platform. Interconnectivity and ease of information sharing are vital to patient-centered care, and luckily, the majority of patients already own the perfect tool to tackle this task. It’s simply a matter of implementation at all stages of the treatment plan.
Increasing drug adherence may already be at our fingertips. Patients given the option to confirm their medication had been taken via a mobile app showed adherence rates 30-37 percent higher than those who did not. That is a drastic increase and could save millions of lives and billions in healthcare costs. Cellphones are not the answer to drug non-adherence but will serve as an integral part of the initiative to improve it.
Patient-centered care is the most effective approach to the treatment of chronic diseases, but it is also time consuming. Making treatment a collaborative effort requires clear communication, accessible information and a robust support network. Phone networks provide ready-to-go infrastructure to help facilitate the process, making patient-centered care both efficient and tailored.
Nicholas Rumble is the founder and CEO of Curaizon.
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