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The Evolving Role of mHealth in Medication Management and Adherence

Healthcare providers are using a variety of digital health tools to help patients take their medications and remain on a care plan. The consequences of non-adherence can be costly - and deadly.

Source: ThinkStock

mHealth offers many unique methods for helping patients take their medicine. And with a healthcare industry seeing non-adherence rates of as high as 50 percent and annual costs of between $100 billion and $300 billion, doctors are taking notice.

To remind people to pick up or renew their prescriptions, doctors and pharmacies are using mHealth platforms that send automated, personalized messages to a patient’s e-mail, smartphone or even a smartwatch (patients can program their own reminders as well). Digital or smart pillboxes, meanwhile, can keep track of medications, remind a patient to take a medication and even record and send that data back to caregivers.

And to make sure the drug is taken and working, mHealth wearables, patches and tattoos can capture physiological data for the patient, caregiver – even the pharmacy or drug maker. There’s also a growing market for ingestibles, small sensors embedded inside the drug capsule that record data from the patient’s stomach after the drug is taken and send that information into the cloud through a patch before ultimately dissolving.

To put things in perspective:

  • Roughly 80 percent of all interactions between a doctor and a patient end with at least one prescription, amounting to more than 4 billion prescriptions a year in the United States.
  • According to the Patient-Centered Primary Care Collaborative, More than 3.5 billion prescriptions are written annually in the United States, and four out of five patients who visit a physician leave with at least one prescription. Medications are involved in 80 percent of all treatments and impact every aspect of a patient’s life. 
  • In 2004, the Institute of Medicine’s report on health literacy estimated that more than 90 million people have difficulty understanding, using and acting on health information.
  • The errors aren’t limited to patients. The Institute of Medicine, commissioned in 2016 by the Centers for Medicare & Medicaid Services to study medication errors, conducted five separate studies that placed the rate of medication errors per 100 doses from 2.4 percent to 11.1 percent in inpatient hospital settings.

Medication management and adherence doesn’t just affect patients and their doctors. Research conducted in 2016 by Park Associates found that more than 10 percent of the nation’s caregivers are also using mHealth tool to track medications for their charges. That same study found that almost 30 percent of caregivers would be interested in using those tools, as would 41 percent of Americans who expect to care for a loved one in the future.

"The demand for caregiving applications is currently unmet and will grow in the future among both consumers and the medical industry," said Harry Wang, senior research director for the Dallas-based market research and consulting firm. "The industry needs to prioritize education and outreach for caregivers and patients and examine ways for the wellness and well-being markets to connect with and inform insurers and medical providers and professionals.”

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DIFFERENT METHODS FOR DIFFERENT STAKEHOLDERS

The consequences of non-adherence are enormous. Patients who don’t take their prescribed medications run the risk of serious health issues, including hospitalization and death. This not only affects clinical outcomes, but adds significantly to the nation’s healthcare bill in terms of avoidable hospitalizations and medication waste.

For doctors, a patient who doesn’t follow a medication plan can rack up thousands of dollars in costs that might not be reimbursed, not to mention draining morale and possibly affecting a doctor’s patient satisfaction ratings. Health systems and the pharma industry, meanwhile, might not be able to judge a treatment’s effectiveness if patients aren’t following the plan.

“A smart mHealth platform allows healthcare stakeholders to become more educated about their patients and gain insight on optimizing their care,” healthcare consultant David J. Fong, PharmD, wrote in a June 2016 blog on the Wolters Kluwer website. “The patient, in turn, becomes better educated and can understand how best to manage their care holistically. The pharmacist, leveraging the power of a smart mHealth platform and the TRUST of the patient, can personalize his or her communications with real-time functionality and information, increase adoption rate, and improve patient outcomes. The payer then gets a lower healthcare cost and can potentially offer lower healthcare premiums. In short, better outcomes could ultimately equal lower premiums and lower healthcare costs.”

The challenge for healthcare providers is configuring medication management in such a way that their patients either don’t know about it or have accepted it as a part of daily life. When a patient pushes back, that greatly increases the chances that he or she won’t take the prescribed medication.

"User-friendly interfaces combined with effective technical capabilities are both required for addressing this market which will continue to grow due to population aging and epidemiology trends," Milos Todorovic, a Lux Research analyst and lead author of a 2016 report on mHealth and medication management, said. "Seamless integration into objects people use on a regular basis would go a long way toward increasing the utilization of the technology and reducing the social stigma that comes with continuous monitoring.”

According to the report, healthcare could save roughly $290 billion a year by using mHealth technology for medication management – though different platforms seem to be working for different stakeholders.

The report analyzed different medication management and adherence platforms based in usability and impact, and finds that patients and their doctors have different ideas of what works and what doesn’t. The patient favors an inexpensive, easy-to-use method that fits into his or her daily lifestyle – such as smart packaging or an app. A doctor is more focused on clinical and regulatory validation and wants something that proves that a drug is being taken and that it’s working, such as a smart pillbox.

“Physicians find the ease of use and drug abuse prevention to be among important parameters that distinguish the hardware solutions from their software counterparts,” the report said. “On the other hand, as the most glaring example of a technology that does not meet user’s needs, logging software/apps solutions do not provide any significant value to physicians, due to the combination of low impact and usability scores driven by the low accuracy, clinical and regulatory validation, and measurement type scores.”

The payers and pharma market, meanwhile, are more focused on confirming that a drug has been taken and analyzing how it works, so they’re more interested in wearable patches and ingestibles.

“The importance of physiological monitoring to pharma companies extends beyond the medication adherence monitoring, as it gives the companies the ability to track the physiological impact drugs have on patients, which is a critical value add during clinical trials,” the report said.

“An interesting thing to point out is that telemedicine solutions score low in payers’ view, predominantly due to the fact that the frequent patient/doctor interaction adds significant costs to the cost of care due to the high cost of medical professionals’ services, most of which is borne by insurance companies,” the report points out. “This represents a significant barrier to adoption from the payers’ perspective, and companies developing solutions that integrate the functionality that allows doctors and patients to use telemedicine to boost adherence need to consider limiting the amount of interaction to contain the costs.”

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Source: ThinkStock

TRYING OUT NEW DIGITAL HEALTH TOOLS

Some providers use a video communications platform to make sure their patients are taking their medications. In places like central California and Baltimore, public health officials are using a digital health technique known as Directly Observed Therapy to help patients diagnosed with tuberculosis. Through an app, the patient takes a video recording when he or she takes a drug, then sends that video to caregivers.

“Our healthcare system is, unfortunately, not designed with the patient at the center – it’s not an effective system to have a person come to the clinic every day, wait in line, sign in, get their paperwork done, just to watch them take medications,” said Baltimore Health Commissioner Leana Wen, who’s been using the platform for more than two years. “That’s why technology can be helpful in increasing tracking and increasing flexibility and availability of treatment for patients.”

"We know it's asking a lot to expect the patient to stay on track with their medications," adds- John McGillicuddy, MD, an associate professor of surgery at the Medical University of South Carolina’s Division of Transplant Surgery, who’s using a $1 million grant to study how such tools can help kidney transplant patients who take as many as 15 different medications a day. "Unfortunately, we also know medication non-adherence and the resulting uncontrolled hypertension are predominant risk factors for premature graft rejection, graft loss and death. With this study, we're looking at ways to keep patients on schedule with a computer automated monitoring system using mobile technology to improve patient outcomes."

Among the more creative mHealth concepts for medication management are ingestibles, or tiny technology embedded in pills that are designed to measure data from inside the patient after a drug is taken.

The acknowledged industry leader is Proteus Digital Health, a Silicon Valley startup launched in 2012. Last year, the company partnered with Lake Tahoe’s Barton Health to test its technology in patients with hypertension. The sensor, about the size of a grain of sand, is implanted in a generic pill and, when swallowed, tracks vital signs and the medication’s effectiveness from the stomach before eventually dissolving.

“Medication adherence is crucial in shaping clinical outcomes,” Clint Purvance, the hospital’s CEO, said. “This allows both doctors and their patients to have the best data available to make decisions on a future course of action.”

“It’s a great tool for us to really understand what a patient is doing,” he says. And while measuring adherence, it also tracks how that medication affects the patient and treats the symptoms.

“There’s a lot of measurement of physiological data with this,” he says. “But more interesting to us is just how well we can measure medication compliance and adherence. … It allows (the patients) to have that data to make the best decisions on their own care.”

For patients who are taking several medications and might not be able to keep track, mHealth companies like Medisafe are building platforms that integrate with the medical record and produce a mobile-accessible medication history. Patients can call up this history on a mobile device whenever they’re confused – and they can show it to their caregivers or doctors.

“Many patients do not know their medication history or don’t take their medications when they’re supposed to,” says Medisafe CEO Omri Shor, who estimates roughly 6 percent of all hospital readmissions can be traced back to medication adherence issues.

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AN EFFECTIVE STRATEGY

The Lux Research report concludes that while all technologies have their advantages, none will be used if they aren’t used consistently by the patient. An effective platform, therefore, must:

  • Support the sharing of data between patients and providers;
  • Be prescribed by providers;
  • Qualify for reimbursement; and
  • Work well for patients who rely on medications to live comfortably or to manage multiple chronic conditions.

“Both the government and insurance companies that bear the brunt of healthcare costs will require patients to adhere to their therapies, with the goal to minimize the expenses currently resulting from poor adherence,” the report said. “The likely mechanism to impose the mandate will include penalties for those patients who fail to comply. As a result, patients will be economically incentivized to use adherence monitoring solutions to prove the adherence. This will significantly increase the addressable market, as more than 4 billion prescriptions are filed every year in the U.S. alone, and each will require the use of one of the adherence monitoring solutions.”

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