Written by Frank Long
Medication non-adherence is one of the biggest problems facing the healthcare system. Even with life threatening illnesses, 50% of patients will be non-adherent to their therapy within 6 months. This article examines the role of digital technology and patient centred design in helping patients to engage with their therapy and reducing non-adherence rates.
The digital healthcare revolution has arrived. Never before have we had such widespread access to technology, communications and onboard health monitoring – thanks in no small part to the smartphone in your pocket. We can monitor our heart rate, our activity, our sleep in greater detail than ever imagined. Through a myriad of IoT devices, we can add multiple other sources of data to give our doctor an ever-clearer picture of our health status. All of this can be done remotely, allowing patients to be monitored and cared for at home, while also freeing up hospital resources. It seems that there are no limits to what can be achieved, and digital services are set to become an important part of every future drug therapy.
One particularly important area is medical non-adherence. In the US 58% of adults are on at least one prescription drug – yet 50% of that number fail to take their medication as prescribed. This is a significant problem. As a result of non-adherence, patients experience compromised outcomes; doctors struggle to create effective treatment plans; and healthcare payers are burdened with high costs for treatment that is not being followed and ultimately is unsuccessful. Non-adherence adds USD100 billion to the cost of the US Health Service each year, and in 2012, the US Surgeon General attributed over 125,000 deaths each year to non-adherence to medication.
Digital technology can help address this problem in a number of ways. Already apps exist to remind patients to take their medication and allow them to log each dose. In some cases, apps are synched to smart injecting devices or smart pill containers to record the dosage automatically – requiring no additional patient intervention. In other cases, these apps are connected to the doctor’s system, communicating your adherence data directly to the clinic. All of which helps forgetful patients stay more adherent and keeps their care team better informed. However, there are two types of non-adherence; intentional and non-intentional. While these solutions combat the latter, they do little to address patients who deliberately stop taking their medication.
Intentional non-adherence is more complex to combat as there can be numerous factors behind it. It can range from patient denial (I’m not ill), to lack of belief (these pills don’t work), to unpleasant side effects (these pills make me feel worse), to false positives (I feel great so I’m cured). There can be many complex psychological reasons behind a patient’s decision to stop following their therapy. In order to counter it successfully, you must understand and address the root cause. This requires a more nuanced approach. As an app that reminds a patient to take a pill that they believe is making them ill will have little effect. Although recording the fact that they are not taking their medication is a good starting point.
What we are looking for is the ability to create behaviour change in the patient, and the key lies in a more effective contextual monitoring and feedback loop. Nudge Theory and Behavioural Economics have a useful role to play in this context – delivering dynamic and actionable messages based on individual patient data. So too does a triage approach that can blend AI with medically trained support to assess individual patient strategies. Longer term the challenge is one of how to keep patients engaged with their therapy and this is also true of any adherence monitoring app.
Of course, an effective solution needs more than just a digital framework. Ultimately healthcare professionals play an important role in delivering and managing the solution. This is one area where more design focus is needed. Alerting the physician or nurse simply puts more stress on an already overloaded healthcare system. Tools that incorporate family members, carers and pharmacies can also be very effective and encounter less resistance and require a lower management overhead from healthcare professionals.
From the HCP perspective, the emergence of adherence apps and monitoring technology is welcome, especially where the clinical evidence points to better patient outcomes. However, it does come with a cost by placing more stress on clinic time and resources. From a physician’s perspective, each patient needs to give consent to be monitored, have the app downloaded to their phone, be trained on how it works and deal with any troubleshooting all of which creates a lot of un-billable man hours. If each prescribed drug had its own proprietary app, then a typical clinic could be supporting 20+ different applications which is more than your average IT department. On top of this, there are well-known issues around integration with hospital EHR systems. We can begin to see how, from the HCP standpoint, the digital healthcare revolution seems a little more revolting.
Ultimately digital solutions will prove a useful tool in combating non-adherence. However, in order to succeed they need to address several key issues:
- Intuitive to use, easy to learn, and patient-centric.
- Reduce, not increase the workload for clinical staff.
- Platform approach as opposed to single-drug solutions.
- Integration with broader EHR systems is a prerequisite.
The digital healthcare revolution is here — but the war on non-adherence is only getting started.
Related Case Study
Frontend.com worked with Merck Group to design Growlink: a connected health solution that syncs data from a patient’s smart injector device and communicates it with their doctor and home carers. This product shows how our patient-centred design process can be used to help improve drug adherence. Read the complete Growlink case study.