The High Costs of Medication Noncompliance

pillsThere are many reasons why patients don’t take their medication as prescribed. Maybe they hate the side effects. Maybe they can’t afford their medication, so they ration it until they can scrape together the cash for another refill. Perhaps their condition is asymptomatic, such as hypertension, so they fool themselves into thinking they don’t need medicine. Or, distracted by the hectic pace of everyday life, perhaps they simply forget to take their pills.

Whatever the reason, medication non-adherence is an expensive and potentially deadly problem, resulting in 89,000 deaths and $100 billion per year in unnecessary hospital costs. The American Heart Association reports that medication non-adherence is the number one problem in treating illness today.

A study published this month in the New England Journal of Medicine makes several suggestions for improving patient compliance, such as lowering co-payments for medications, using healthcare information technology to track prescriptions, and an outcome-based payment system for providers. But what about patients who forget to take their pills? Elderly patients who are on a complex drug regimen are especially likely to skip doses or take double doses. For patients such as these, the standard seven-day pill box may not suffice. A number of companies have developed automated pill dispensers to aid medication compliance:

InforMedix markets the Med-eMonitor System, a multi-part medication compliance solution that includes a medication device and a database. The device timestamps the date, time and medications taken, and then the Med-eXpert database compiles the data for use by researchers.

The SIMpill Medication Adherence System text-messages the patient’s mobile phone if the patient does not take their medication or takes it at the incorrect time. If the patient still does not take their medication, an alert can be sent to their caregiver or healthcare provider. The system also monitors prescription refills and alerts the pharmacy when the patient is running low.

INRange Systems manufactures EMMA, the first and only remote medication management system approved by the FDA. Medications are packaged in blister cards and loaded into a central delivery unit. The patient’s dosing schedule is transmitted, either by the patient or a healthcare provider, to the unit using a wireless broadband connection. When it is time for the patient to take their medications, the unit alerts the patient, who tells the system to dispense the pills.

MedReady offers several different models of its automated pill dispenser. The FL model has a flashing red light for patients who have trouble hearing alarms. The LF model emits a low-frequency tone for patients who have problems hearing high frequencies. MedReady 1650 sends caregivers a daily report on their patient’s compliance.

Dispense-a-Pill, developed by HealthOneMed, can store a 90-day supply of up to 8 medications. Patients can also enter information for injectable or liquid medications. An alarm sounds when it is time for the patient to take their medicine. If the patient does not comply, a voice notification is sent to the caregiver’s phone.

Stephen Prange, director of business development at HealthOneMed, believes that education is the key to improving medication compliance—informing patients why they need to take the medication, what it does, and what the warnings are. Prange says HealthOneMed takes advantage of the strategies that work. “The issue right now,” says Prange, “is getting insurance companies to recognize the importance of this and to reimburse for it.” He says that automated pill dispensers are covered if part of a personal emergency response program that provides services such as medication management and vital sign monitoring, but they are not covered on their own. Dispense-a-Pill was recently selected by Doyle Security to provide an automated pill-dispensing solution for their medical monitoring program.

Medication compliance can ultimately lead to lower costs and better outcomes. “This medication management push is really geared toward keeping people in their homes,” says Prange. The average hospital stay due to noncompliance is 4.2 days; one hospital stay can cost a fortune. In addition to financial costs, hospital stays can affect quality of life and patient mortality. Elderly patients may become disoriented or confused if moved out of their homes, and the hospital can be a dangerous place for patients with weakened immune systems. The elderly are particularly susceptible to hospital-acquired infections, which kill an estimated 100,000 people annually in the U.S.

Approximately 10 percent of hospital admissions are caused by medication noncompliance. How can we ensure that patients stick to their medication regimens?

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