Much of the medicine prescribed to treat chronic conditions like high blood pressure and diabetes doesn't work-because patients neglect to take it.
But what if someone, or something, called to remind them every time they were due for a dose?
Express Scripts Inc., the big St. Louis pharmacy-benefit manager, is about to test an electronic pill container that issues a series of increasingly insistent reminders, in a national study among patient members.
The container-actually a high-tech top for a standard pill bottle called a "GlowCap"-is equipped with a wireless transmitter that plugs into the wall. When it is time for a dose of medicine, the GlowCap emits a pulsing orange light; after an hour, the gadget starts beeping every five minutes, in arpeggios that become more complicated and insistent. After that, the device can set off an automated telephone or text message reminder to patients who fail to take their pills. It also can generate email or letters reporting to a family member or doctor how often the medication is taken.
It is one of the high-tech ways companies are grappling with medicine noncompliance. Only about half of patients who are prescribed a medication for a chronic condition are still taking the drug regularly after a year, says Daniel Touchette, assistant professor of pharmacy practice at the University of Illinois at Chicago.
Patients have lots of reasons for not taking their medicine. Some experience unpleasant side effects. Others believe the drug doesn't work. They can't afford the cost of taking it every day. Or they simply forget.
Novartis AG has licensed rights to a minuscule edible chip, from Proteus Biomedical Inc., which attaches to a pharmaceutical; when it hits the patient's stomach, the chip sends a signal to the patient and designated individuals. Another system, from Leap of Faith Technologies Inc., issues automated phone reminders to patients, who can scan bar codes or electronic chips on their drug labels to confirm they're taking the right medications. Various applications for the Apple iPhone also offer prompts to take medicine.
An Express Scripts rival, Medco Health Solutions Inc., is tackling noncompliance with efforts including pharmacists, who use in-depth databases to detect when patients aren't refilling prescriptions regularly and call to offer information. Increasingly, insurers and employers are cutting or eliminating drug co-pays for patients with chronic conditions; the thinking is that patients will take medications more often if they don't have to pay as much for them.
Minding Your Medicine
Listen to a telephone prescription reminder from Vitality Inc.'s GlowCap pill bottle, which is being tested by Express Scripts.
The most effective programs combine education and reminders, says Daniel Touchette, assistant professor of pharmacy practice at the University of Illinois at Chicago. But even they improve the share of patients adhering to drug regimens by no more than about 10%.
In about a month, Express Scripts will start a small test of the GlowCap, made by Vitality Inc., a Cambridge, Mass., maker of high-tech health packaging. Express plans a larger trial focused on drugs for cholesterol, diabetes, high blood pressure and heart failure this summer.
Bob Nease, Express Scripts' chief scientist, says the goal is to see if the gadget improves pill-taking, and also to use detailed information that the device beams wirelessly to learn more about how and why patients take-or fail to take-medication. "It is an outstanding instrument" for tracking such information, he says.
Patients using the GlowCap get reminder calls only if they opt to do so. They can opt out of having doctors and family members receive email updates. One issue the study will address is whether the device raises patients' privacy concerns, Dr. Nease says. Dr. Nease declined to comment on the study's cost or size. Participants won't have to pay for the devices, which sell online for around $100.
Some patients won't welcome the idea of having their daily medication monitored. Vera Karger, a retired Monroe, Conn., speech pathologist, says she wouldn't mind the lights and noises, but emails to her doctor or family would "make me feel inept, or like I was being regarded as a child." And her low-tech seven-day pill boxes , one for her two morning medications and one for the two she takes in the evenings,work fine, she says.
Richard Rowe, a Belmont, Mass., acquaintance of a Vitality executive, tried the gadget and says the report to his doctor "significantly increased my motivation" to take his cholesterol-lowering statin drug. "I didn't want to be embarrassed in front of my physician," says Mr. Rowe, chief executive of an educational nonprofit. Still, the bottle's beeping was "a little annoying," he noted.
From Anna Wilde Mathews, Wall Street Journal
Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP
Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP
