According to the World Health Organization, adherence to long-term therapy for chronic illnesses in developed countries is only about 50% (while predictably being even lower in developing countries). Even leaving aside the matter of people not getting medical care and not being told the prescriptions they need, about half the people who are prescribed medication don’t take it, at least not consistently at the right time in the right dosage.
The problem tends to be more acute among the elderly, who on average have more conditions needing medication, and more medications to keep track of, and who are more prone than the general population to issues of Alzheimer’s and memory loss.
Needless to say, the failure to keep up with one’s medications can have devastating consequences. When people fail to medicate properly for conditions such as high blood pressure, diabetes, asthma, AIDS, etc., the result is significant numbers of unnecessary hospitalizations, and even avoidable deaths.
In short, people aren’t taking their pills. Why? And what can be done about it?
There are a great many reasons those 50% or so of people don’t stick to their medications. Sometimes they genuinely misunderstand the instructions and thought their doctor told them to take one pill every four days rather than four pills per day. Sometimes they’re wary of the side effects, and so compromise by maybe taking less of the medication than they’re supposed to. Sometimes they base their decision on whether to take the medication on how they feel a particular day-“I don’t need my pills today; I feel fine.” Sometimes they simply forget, or lose track. They think they probably took their pills earlier today, but aren’t really sure.
For some of these issues, it’s hard to come up with a technological “fix.” Really they’re about better doctor-patient communication, better patient education, etc. For example, there are understandable, explainable, factual reasons that “I don’t have any symptoms today, so there’s no need for me to take my medication” is flawed reasoning. People who think that way aren’t lacking a piece of technology; their lacking relevant knowledge and/or logic.
But for other issues, it really does help to have some way to “prod” people, to remind them to take their medication.
There are many ways to do this, ranging from the decidedly low tech to the higher tech.
At the simplistic end of the scale is simply writing it down. Whether the person is more comfortable with a pencil and paper, or a spreadsheet on a computer, they can write up a grid showing what pills are to be taken when, and then simply check off a box every time they take their medicine.
There are specially constructed pill boxes where one can place ahead of time all one’s pills in the proper slots for the different days of the week and times of day. Getting ready to sit down to lunch on Wednesday and it hits you that you’re not sure if you yet took the pills you were supposed to take in the morning? Check the Wednesday morning slot on the pill box. If it’s empty, you did; if they’re still sitting there, you didn’t.
People can now register with third party services to deliver reminders to them, by phone or e-mail. Much like a hotel wake-up call, if you’re supposed to take your pills at noon, the phone will ring at noon everyday with a recorded reminder. Or if you’re online all the time and so prefer e-mail, you’ll get an e-mail when you’re supposed to take your pills, and you can get in the habit of not deleting the e-mail until you’ve taken them.
A device such as a pendant or watch can be worn that is programmed to beep at designated times when one is supposed to take one’s medication. With a large enough watch face (or a cell phone or other device can be used), there can be not only an audible reminder, but text-e.g., “4:00: 2 diltiazem.”
At the higher tech end are electronic pill dispensing systems. These are programmed in advance to dispense the proper pill in the proper dosage at the proper time. The person doesn’t have to remember all the details of what they’re supposed to take and when; if the pill has been dispensed, that tells them they’re supposed to take it.
Some devices of this kind can even be remotely monitored to ensure patient compliance.
But none of these are Big Brother-style techniques to get unwilling people to take their medication. (If they were, they’d be pretty darn easy to beat.) These are all just ways to help people who want to take their pills but sometimes forget, or make mistakes, or get confused. As such, they by no means eliminate non-compliance, but they can certainly help a lot of people not miss their medication.
Brian Dolan, “Can technology address medication adherence?” Mobi Health News.
Neil Osterweil, “Hey, You, Take Your Pill!” Medicine Net.
“Managing Medication is of Major Importance to Your Health and Well Being. Do You Need Help?” Aging Home Health Care.