A now famous report from the WHO asserts that medication adherence is about 50%. That is, about half the time when a doctor prescribes a medication, the recipient actually takes the prescription as directed. The WHO report further divides the problem of adherence into reasons that include forgetfulness, trust issues, cost concerns, lack of appreciation for the need, side effect avoidance, etc. I’m not aware that anyone has been able to quantify what contributions these variables make to the entire problem of adherence.
At the Center for Connected Health we have a great deal of interest in this problem.
We just released interim data on a study we’ve done in collaboration with a firm called RxVitality on a product called the Glowcap. The Glowcap has several features of interest that chiefly attack the forgetfulness component of adherence, but also some of the psychological aspects as well. The core of the technology is a medication bottle cap that fits any standard pharmacy bottle. The cap has a sensor in it that fires when the cap is removed. It also has a blinking light and can play a tune.
I’ve been using the Glowcap myself. I take a statin at bedtime. I set the Glowcap to start reminding me to take my pill at 9 pm. At that time the bottle cap flashes. A related night light attachment that can be put in a different room flashes as well. At 10 PM if I haven’t taken my pill, the bottle cap starts to play a brief tune periodically. If I haven’t taken my pill at 11, I get a phone call from RxVitality reminding me. The system also sends me a weekly email on my adherence and a monthly paper letter showing my adherence. These can be shared with others such as a loved one or a health care provider.
When we studied this system, we found that folks who used all components of the system – light and sound prompts and personalized reports – had adherence rates of 98-99%. Baseline adherence for another comparitive group was about 70%. The results were statistically significant. We also offered a financial incentive to one group of participants, but their adherence was no different than the group that received just the complete Glowcap solution.
Several interesting conclusions can be reached. Firstly, forgetting is a big component of non-adherence. Of course our sample is biased in the sense that we recruited individuals who are willing to be studied. This is a known problem with clinical studies. We never get the folks who are so checked out that the ingore their health completely. It’s also safe to assume that we don’t have as many socioeconomic issues in our sample as the general population. Still, the result is amazing to me.
I was struck by my own behavior. I would have said I was 100% adherent to my regimen and have found since using the Glowcap that without it, I’d be more like 80-90% adherent. In addition it is somewhat surprising that the financial incentive did not have more of an effect.
The results make the case that Glowcaps, or similar technologies, should be ‘standard issue’ with any prescription if we can get the price point low enough. It Is not hard to calculate the ROI on medication adherence. While Glowcap does not solve all of the associated problems, it is none the less an impressive tool.