A Framework for Studying Patterns of Effective Medication Adherence

Introduction

With 3 billion prescriptions every year in US (Fenton, Blyler, & Heinssen, 1997; Dunbar-Jacob & Mortimer-Stephens, 2001), the cost of medications has been increasing significantly. Further, it is estimated that only between 50 to 60% of such medications are consumed as prescribed (Fenton et al., 1997). The reasons for not taking medication include forgetfulness (30%), other priorities (16%), decision to omit (11%), lack of information (9%), and emotional factors (7%) (Osterberg & Blaschke, 2005). The non-adherence to medications leads to 125,000 deaths and $90 billion in additional hospitalization and procedures every year in USA (Varshney, 2009). In general, 80% medication adherence is considered satisfactory; however a higher level may be needed for some specific conditions, such as 95% for HIV medications. We focus on studying medication adherence for people who are staying at home, and not in a specialized care center (nursing homes and assisted living) where medications are professionally managed.

The adherence to medication has been monitored since the time of Hippocrates, when “the effects of various potions were recorded with notations of whether the patient has taken them or not” (Osterberg & Blaschke, 2005). Currently, some patients devise their own medication management using the spatial features of their homes, daily routines, and how and when they visit certain places to help remember to take medications (Palen & Aaløkke, 2006). In general, most interventions in the literature (Fenton et al., 1997; Dunbar-Jacob & Mortimer-Stephens, 2001; Osterberg & Blaschke, 2005; Varshney, 2009; Palen & Aaløkke, 2006; Siegemund & Florkemeier, 2003; Wan, 1999; McDonald, Garg, & Haynes, 2002) can be classified among three classes: patient support/motivation, reminders/monitoring and improved scheduling. Wireless technologies, such as sensors, RFID, personal area networks such as Bluetooth, wireless LANs among others, can be used to improve adherence to medications by supporting some of the interventions (Varshney, 2009). The specific reasons include (a) personal nature of wireless technologies, (b) immediate attention given by the users, (c) widespread use even among the elderly, and (d) mobility needed to support daily activities of patients. In simple terms, the use of wireless technologies in medication adherence involves reminding patients to take their medications at certain times. The implementation is usually a pill container with alarms that go-off at certain times and the pill container also remembers how many times it has been opened and closed. More sophisticated implementations include Magic Medicine Cabinet (MMC), which enables reminding, vital signs, and interaction with healthcare professionals (Wan, 1999). Smart Medicine Cabinet uses RFID tags to monitor medication boxes and to communicate with a cell phone (Siegemund & Florkemeier, 2003). It also supports reminders, query for contents (medications), expiry date detection, and medication recalls. Any failure or inaccessibility to such system could lead to the patient missing an important dose. The systems described above are not portable, thus very limited for patients with varying social and travel schedules. Another work focuses on a wireless-based smart medication system which can support (a) communication with patients, (b) monitoring of medication consumption, (c) context-sensitive reminders to patients, and (d) multiple interventions for medication adherence (Varshney, 2011).