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I admit it: I often forget to take my fish oil tablet, one of the several tactics my doctor recommends to drive down my bad cholesterol. It’s a fact of life; everyone forgets to take a medication dose at one time or another. But as we age, the list of medications prescribed by our doctors grows and the number of times per day we have to think about it multiplies. For a growing number of Americans, forgetting a medication dose or taking the wrong dose can threaten both health and quality of life. This failure to follow the doctor’s prescribed orders is what the medical community calls “noncompliance” or, more recently, “non-adherence.” Both of these terms mean the same thing: that the patient is not properly following a prescription regimen.
A Massive & Growing Problem
This is a big problem. To put it into perspective, let’s take a look at the facts. The National Council on Patient Information and Education says that an estimated 90% of Medicare recipients take prescription medications and many are nonadherent. In a 2007 survey of 17,000 Medicare beneficiaries, two out of five seniors reported taking five or more prescription medications. According to the New England Journal of Medicine, costs associated with this non-adherence range upward of $1 billion annually in hospital costs. And the FDA estimates that more than two million serious adverse drug reactions occur each year, reporting that adverse drug reactions are the fourth-leading cause of death, responsible annually for about 100,000 deaths.
Even when the doctor has provided a regimen that the patient dutifully agrees to, and even though these prescriptions are filled at various pharmacies, the medications must still be sorted and then scheduled collectively. Today there are a number of medication reminder technologies, either on the market or in the process of being developed, which supplement or replace pharmacy-loaded or manually filled pill packs by helping to ensure that the senior remembers to take the right dose of medication at the right time. And new products and services are emerging daily.
Three Levels of Intervention
Medication reminder technologies fall into three basic categories: (1) telephone-based reminders, (2) reminders integrated as part of home monitoring or safety devices and (3) electronic pill-dispensing systems. How do you know which of these product types is appropriate for the situation? Base your determination on the degree of intervention necessary to manage the drug regimen. For example, if the senior is capable of purchasing and storing all of his or her medication and simply needs a reminder to take them, then a phone-based solution may be enough. On the other hand, if a large quantity of pills must be preloaded into categories and taken scheduled times, then a pill box solution may be just the thing. And it's worth considering a personal emergency response system (PERS) that incorporates medication reminders if other safety factors (like ) are involved.
Telephone-based Reminders: Lowest Cost & Least Intervention
Telephone calling services require no special phone or equipment. Here’s one example. Database Services Corporation, a provider of automatic dialing services in use in many communities, now has an individual Medication Reminder Service that seniors or their caregivers can simply register for and then receive automated reminders to take their medications. The cost for the service is $14.95 per month. If a person doesn’t answer the phone or acknowledge the reminder, the system notifies a designated contact by email or telephone.
The Pill Phone carries this concept one (very large) step further. Available through wireless phone carriers like Verizon Wireless or AT&T, the application can be downloaded from the carrier Web site and costs around $4.00 per month (in addition to wireless service costs). A mobile version of The Pill Book, the Pill Phone is an online application that provides information on 1,800 different drugs, including dosage, possible side effects and drug interactions. Users go online to view drug information and set up reminders and designated contacts.
Integrated with Personal Emergency Response Systems & Services
There are numerous personal emergency response systems, many of which are available through your local pharmacy. These services are built around various wearable products typically sold as pendants or watches. Some, like Response LINK, include programmable medication reminders. Other services, such as Medic Alert, are built on a personal emergency response system and service like Philips Lifeline. I am intrigued by an extension that Philips offers—a large-button telephone that speaks the programmed reminders—called, aptly, “CarePartner Telephone with Reminders.” It works with the Philips Lifeline pendant or watch, has a hearing-aid compatible handset, includes a voice clock and also speaks numbers as they are being dialed. The cost varies by geographic region, but the Philips site describes it as “as little as a dollar per day.”
In addition to the PERS pendant, Health Watch provides linkages to a medication-dispensing pill box unit. If you are considering or have already made a selection of a PERS medical alerting service, ask the service provider whether they link in a medication reminder or offer an electronic pill box (or whether they plan to offer these services in the future).
Electronic Pill Boxes
For seniors who can load their own pills or count on nearby caregivers to help—including aides in independent or assisted living—electronic pill boxes or dispensers with programmable reminders may be a good choice. About the size of a purse, the Med-eMonitor from InforMedix is a programmable device that combines a portable pill box and a docking station with a Web-based connection to a drug database (similar to The Pill Phone’s). It’s programmed remotely via the Internet, costs roughly $40 for a one-time setup and around $60 per month. It is pre-loaded with the pills, has a large-font screen and beeps when it is time to take the pills.
You may also want to consider more sophisticated and lockable electronic pill dispenser systems with heftier price tags (in the $700–900 range), since they don’t require monthly service fees and do enable loading a week’s supply of medications. A couple of examples include those from CompuMed and a new offering called the AutoPills Dispenser from AutoPills. These types of electronic pill boxes make the most sense in facilities, or at home if there are family members or home health aides to configure them.
Awareness & Use of Technology-based Medication Reminders
Are seniors and caregivers aware of the medication reminder options available to them? Unfortunately, for the more evolved medication reminder technologies, it seems the answer is no. AARP’s recent Healthy @ Home survey of 1,023 caregivers and 904 seniors age 65 and older examined respondents’ familiarity with electronic pill boxes. The study points to a gap between awareness of electronic pill boxes and the willingness to use them, among both seniors and caregivers. Twenty-one percent of caregivers were familiar with electronic pill boxes, compared to 13% of the seniors surveyed. However, 40% of seniors were willing to use an electronic pill box and 61% of caregivers were also willing to try it.
When thinking about medication reminder technologies, no matter which one you choose, it is just as important to try to envision the patient’s evolving need for intervention as it is to think about what his or her current needs are, so be sure to consider the product or service’s and capability to be upgraded later.
First posted 10/29/08 in Laurie Orlov's Aging in Place Technology Expert column on Gilbertguide.com