Medication non compliance
Charbots and Avatars
Peak15 is a Melbourne-based digital health reform group. They run monthly events on meetup, bringing together tech entrepreneurs, health professionals, community groups and managers of health facilities.
Last Tuesday’s meetup was dedicated to one of healthcare’s biggest problems. Over 50% of people prescribed medical treatments by their Doctor, do not complete their recommended plan. The cost of re-admissions to hospitals for avoidable re-admissions linked to non-compliance with medications, is estimated to be millions of dollars every year.
The causes of non compliance is a complex one. Lack of honest discussion about the side effects of drugs from some Doctors is one issue. Refusal to take personal responsibility for maintaining their health by some patients is another. And aggressive advertising campaigns that promoting ‘alternative therapies’ that have little or no clinical evidence behind them are another.
There were three guest speakers at this event, all women with very different slants on the causes of non-compliance and ideas on how to overcome the problem.
The first speaker was Kate Porz from Pfizer. Kate is the portfolio manager and co lead in the Healthcare Hub in Melbourne. As a registered pharmacist she is interested in the digital tools that can improve the quality use of medicines and increase medication compliance.
Kate outlined a number of major statistics.
Over 50% of people do not take their medications – Dhruv Khullar The Washington Post
In some 20 percent of cases — and as many as 30 percent — prescriptions for medication are never filled – The Atlantic Brian Fung
Of all medication-related hospital admissions in the United States, 33 to 69 percent are due to poor medication adherence, with a resultant cost of approximately $100 billion per year. Working with the Noncompliant Patient Fred Kleinsinger
Of all medication-related hospitalisations that occur in the United States, between one-third and two-thirds are the result of poor medication adherence – Medication Adherence: WHO Cares? Marie T. Brown, MD, and Jennifer K. Bussell, MD
Nearly 80 percent of patients regularly take medications dosed once a day, but only half do when they’re dosed four times a day. The Washington Post Dhruv Khullar
A text messaging system, sending automated, pre-scripted texts, increased self-reported patient adherence to medications by 12%, care plan goals by 7% and appointment attendance by 40%. Fico blog Joshua Schnoll
Pfizer is currently supporting the health startup community to overcome non-compliance and other pharmacy related problems.
Examples of new technology based adherence tools are
- Caduet (a combined colesterol + blood pressure medication)
- MedAdvisor a script reminder app
- HemaGo a motivational app for people with hemophilia
- AliveCor a hand held device that can take a clinical grade ECG
- Perx an app to reward people for taking their medications using gamification
- Telesofia Medical is personalised educational platform that uses videos.
“Drugs don’t work in patients who don’t take them.”
US Surgeon General, C. Everett Koop,
Prof Kim Bennell spoke next. She is a research physiotherapist with a particular interest in non-drug management of osteoarthritis. Kim works at the Centre for Health, Exercise and Sports Medicine at the University of Melbourne.
Kim talked about the lifestyle behaviours linked to diseases like osteo-arthritis, such as obesity and lack of physical activity. She pointed out that when you look closely at the data on non-compliance, different lifestyle changes have different non-adherence rates. For example improving diet, taking medications and giving up smoking all are followed up at different rates by people who have been given the same information by their Doctor.
Kim questioned how accurate our current data collection non-compliance is, and how you can compare patient’s personal stories versus the data collected from smart devices measuring things like exercise levels?
She feels that barriers to compliance behaviour include education levels, personal motivation and opportunities to make lifestyle change. She also pointed out that different population groups have different issues and and need different strategies.
Like Kate, Kim is concerned about the implications of not taking medications such as foot amputations from chronically high blood sugar or stroke from blood clotting due to an irregular heart. This is a substantial problem does not receive adequate publicity, funding and support.
“Keep a watch also on the faults of the patients, which often make them lie about the taking of things prescribed.”
Finally, Dr Bree Burgin spoke from Work Healthy Australia, a private company that works directly with employers and employees. Bree is also a registered Chiropractor. She believes that the health industry needs to put the patient first, as in any modern commercial industry and that health services need to be using objective data when making assessments, not hearsay or tradition.
Work Healthy Australia is building a chatbot to help people stay on track with adherence to treatment programs, and maintain their engagement. Bree pointed out that studies of long-term use of fitness trackers, showed consistent patterns, based on natural patterns of behaviour.
The chatbot who is named ‘Janet’ has been successfully tested and been found to successfully improve non-compliance rates. Not only that, 55% of people surveyed have stated that they are prepaid to replace a Doctor’s visit with a chatbot.
Bree says it’s important to find out what works and explore that, as opposed to simply turning out dated medical records into a digital format.
‘Modern use of technology does not simply mean digitalising an unsatisfactory experience’ she points out.
“The future of healthcare is integrated into everyday life, personalised and instantly accessable.”
Dr Bree Burgin