More on Pharmacy Best Practices (Sept. 2006): Using technology to promote compliance

Clever approaches can help patients adhere to drug regimens, and managed care organizations are increasingly adopting the technologies that enable those approaches.

Partners Telemedicine, based in Boston, has created a successful link between an electronic medication container and a feedback device. The container, called a "smart" pill bottle, developed by SIMPill in South Africa, sends a message when the bottle is opened, and a glowing feedback device, from Cambridge. Mass.-based Ambient Devices, glows different colors to represent information it receives via a pager network. When medication is overdue, the light glows red; when the pill bottle is accessed, the light changes to green.

Joseph Kvedar, MD, founder and director of Partners Telemedicine, says the consumer technology is a first step in understanding how subtle signals can influence behavior. He anticipates that in the near future, technology devices might even show a short video clip about a disease and offer incentives such as song downloads via cell phone. "The technology enables more care where people are and reminds and educates them at the same time," he says.

Kevin Wildenhaus, director of behavioral science at HealthMedia in Ann Arbor, Mich., says that medication compliance is a complex issue with at least 50 different reasons for not taking a drug or not taking it as prescribed. "It is not sufficient to just give a patient instructions; you need to offer solutions to better manage a condition by using a behavioral change approach. In our quick-fix society, everyone wants immediate results," he says.

Wildenhaus outlines underlying reasons for non-adherence: medication factors, such as side effects; complex treatment regimens including frequency and duration; health status; cost; social support; and patient factors, such as self-confidence in taking medications, motivation to manage health and attitudes toward a drug's benefits.

HealthMedia has developed Care for Your Health, a customized software program for managed care organizations, large employers and disease management companies. The program addresses any chronic condition that can be self-managed and delivers tailored information to each patient based on answers to questions and in the context of each factor affecting compliance. Although program information is delivered instantly, Wildenhaus claims that it is individualized. Care for Your Health has garnered improvements in health, patient satisfaction, communication between patients and physicians, management of chronic conditions and medication compliance.

HealthMedia designed a program specifically for compliance with oral medications for type 2 diabetes. At baseline, only 27% of those enrolled in the program were fully compliant, increasing to 75% after 30 days and decreasing slightly to 72% after three months. Wildenhaus says that only 4.5% were unable to make positive changes.