The good news on the medical front is that with advances in therapy, people with chronic diseases are able to remain in their homes and even live active lifestyles, which improves their quality of life and can save them, the government (Medicaid/Medicaid), and the insurance industry money. But — and it’s a big one — those savings can only be achieved if those patients adhere to their medication schedules.
Non-adherence first came to the forefront of awareness back in 2009, when the New England Healthcare Institute (NEHI) issued a report that found that failing to take medications as prescribed leads to poorer health, more frequent hospitalization, and a higher risk of death. It also costs $290 billion annually in increased medical costs.
While that report raised alarms, we haven’t made much progress in solving the challenge. According to the AMA, studies conducted in 2018 showed that “most patients only take their medicine as prescribed about half the time and are often reluctant to tell their doctor, while a quarter of new prescriptions are never filled.”
There are plenty of digital apps on the market that reminds people to take their medications (even Apple has released one), which are useful for patients who are willing to adhere to their doctor’s orders but have trouble remembering to do so. They’re a small minority, however. When the AMA surveyed patients as to their hesitancy, forgetfulness didn’t even make this list. Fear, cost, misunderstandings, and worry, however, did.
If we can create a home-based health-tech solution that addresses these concerns, perhaps we can finally make a dent in non-adherence.
Opportunities to Explore to Fix the Non-Adherence Challenge
The biggest opportunity to fix the non-adherence problem lies in medication literacy. Studies show patients have been prescribed therapies in a doctor’s office, but later have questions about them. Worry sets in if they’ve seen a family member or friend struggle with the side effects of those medications. Patients are left to weigh the pros and cons of taking a prescription on their own. Without immediate (and streamlined) access to answers, adherence isn’t likely.
Additionally, there is a huge opportunity to expand the present-day reminder concept to every person who plays a role in the patient’s medical journey. As it stands today, a doctor’s office will send a prescription to a pharmacy on behalf of the patient but that doctor’s line of sight into the journey ends there. The pharmacy receives the prescription, but simply waits for the patient to arrive to pick it up. In the meantime, the patient’s caregivers and family members are left in the dark, unaware of what has been prescribed and why. A health-tech app that keeps everyone in the loop provides an opportunity to resolve the patient’s concerns and reasons for non-adherence.
Streamlining the Complexity of Medication Regimes
In some cases, knowing which medications to take and when throughout the day can be very complex. Some need to be taken on an empty stomach, while others can only be taken 30 minutes or an hour after someone has eaten.
Imagine a health-tech app in which the user (or family member) enters the medications prescribed, and the app calculates the ideal time to take each and avoid side effects, such as an upset stomach.
Personalized reminders from an informed home health aid have a higher success of adherence over automated app notification (a responsibility that adult daycare centers take on in the absence of family members to do that for the patient).
Access to Medical Literacy
We can combat prescription hesitancy through easy access to information. Imagine a healthcare app that addresses the patient’s fears and misunderstandings by answering key questions such as: is this fast-acting? Do I need to change my diet? Does it interact with alcohol or grapefruit juice?
Patients make adherence decisions in the period between visiting a doctor and going to a pharmacy. If we can provide them with the information to allay their fears and worries digitally, we greatly increase the probability of adherence. This is especially true in cases when patients are reluctant to share their fears with their doctors or pharmacists.
Strategic chain of escalations
What I like about the Apple app is that it allows the user to opt to share his or her medical data with family members, which is good, but imagine a monitoring tool that reminds a patient to take medication as well as acknowledge that the dose was taken by clicking or swiping on the app. If that acknowledgement never occurs, an alert can be sent to a spouse or adult child who can call the patient to remind him or her personally, as well as address any challenge that caused the prevention. For instance, if the patient is out of medication or a food item that must be taken with it, the family member can run to the pharmacy or store on their behalf.
Integration of medical records
This doesn’t exist yet, but if a home health monitoring device, along with data and AI/ML, had access to a patient’s medical records, it could help patients with dosage titration with a new prescription. It could also do all the data entry on behalf of the patient automatically (thereby increasing the likelihood that the app will be useful to a patient).
It will also be vital to patients who are asked to list all of the prescriptions they take as they fill in the new-patient registration forms when they visit a doctor for the first time. And, it will also flag potential issues automatically, such as when one doctor prescribes a medication that has a negative interaction with one the patient is already taking but forgot to include in the registration form.
Getting the User Experience Right
Clearly, developing a health-tech tool that meets the use cases described above will take some investment, especially in terms of user experience. People with chronic medical conditions are often older and aren’t typically digitally savvy. It will be a challenge (but not an impossibility) for an 80-year-old who lives alone to integrate his or her medical records and establish a chain of escalation, as well as use it on a daily basis. What’s more, for true adherence to occur, the app itself should factor in the unique in-home experiences and lifestyle choices of the user.
But we do have some trends in our favor. First, remote tools for patient monitoring are proliferating, tracking everything from blood pressure and glucose levels, which means that the psychological barrier has been broken. And Pew Research reports that 61% of people over the age of 65 now own a smartphone and that the number is steadily increasing, so it’s likely that a sizable portion of the people who will benefit from an app have the equipment they need to use it. Other devices, like a standalone tablet, can be deployed for people who don’t own a smartphone, and if a healthcare tech app proves to be truly effective, insurance companies may even pay for them.
I have no doubt that innovation can address the $290 billion non-adherence challenge, as long as we focus on its root causes.
About Trenhold Ninestin
Trenholm Ninestein, Director, Product Management at Rightpoint, is a veteran product leader with a passion for mobile design and behavior change. Equipped with a background in film, television and radio, his art of storytelling has adapted to delivering innovative technologies. He has spent the last 15 years focused on delivering mobile-first solutions in education, staffing, and healthcare.
