Medication adherence is key to improving outcomes, reducing costs
A variety of recent government mandates and industry reforms have begun promoting innovative approaches to enhancing quality of care and controlling healthcare spending. Many of these programs focus on improving the health of populations that require significant healthcare services because of complex, chronic conditions such as diabetes, hypertension and heart disease.
There are many different drivers that have been shown to improve outcomes in these populations, including patient education, improvement of the patient/provider relationship and assistance with medication management. Medication non-adherence is a particularly expensive and prevalent problem, especially in the case of older individuals with complex conditions. Medication management can improve quality of care and control costs by lowering hospital and nursing home admissions, reducing complications, and enhancing patient satisfaction and overall health. In fact, an estimated 23% of nursing home admissions are related to the inability of individuals to self-manage medications while non-adherence more than doubles the risk for medication-related hospital admissions.1,2,3
Certain serious conditions, such as hypertension, are particularly impacted by medication adherence, which has shown to improve blood pressure and reduce related health consequences such as heart disease and stroke. For example, the reduction of systolic blood pressure by approximately 20 points (which can be realistically achieved through the proper medication protocol for many patients) has been shown to reduce the mortality risk by 50% in this population.4
The cost of medication non-adherence
While estimates vary, experts agree that medication non-adherence represents a large, preventable percentage of overall healthcare spending—anywhere from $13-100 billion annually. 5, 6 A Health Affairs study published in 2011 reported that for patients with four chronic conditions (congestive heart failure, hypertension, diabetes and dyslipidemia), adherence to prescribed medications drove savings that ranged from $1,200 to $7,800 per patient annually and every additional dollar spent on medicine generated between $3 and $10 in savings on medical care.7
There are also many other “hidden” costs related to medication non-adherence. Individuals
attempting to care for a loved one whose health is impacted by medication non-adherence can suffer from mental health issues, lowered work productivity and absenteeism. Caregivers can also suffer serious health consequences due to stress and its effects on their own quality of life. As a result, improving medication management and related health issues can positively impact not only individuals with chronic conditions, but also caregivers, families and employer groups.
A complex problem
There is no single cause for poor medication adherence. Just as every individual’s health and lifestyle are unique, their reasons for not taking medication as prescribed are just as varied. Stress, forgetfulness and concerns about cost and side effects as well as an inability to understand the complexity of a medication regimen have been shown to drive non-adherence.1 Senior populations in particular share many of these attributes due to cognitive difficulties and multiple, complex conditions as well as physical and financial limitations. For example, the average 75-year old suffers from three chronic conditions and takes five different medications.8 Seniors without adequate in-home support and guidance from caregivers or loved ones are also at higher risk for non-adherence.
Effective medication management programs must address many of these diverse and complex issues in order to improve adherence. For example, medication reminder systems that rely solely on sight or auditory alerts might fail for individuals with limitations in these areas. Others that are difficult to operate will be a challenge for those who have problems with dexterity or cognitive issues. Relying on patient education alone also has limited application since many patients need in-home support on an ongoing basis. As a result, ease of use, affordability and convenience are all highly important elements that will support the correct and continued use of a medication management system.
Exploring the dimensions of effective medication management
One recent approach to medication management has shown promising results through continued commercial use as well as an academic pilot program that tested medication adherence in a hypertensive population. The MedMinder solution utilizes a programmable pill dispenser tool that provides multiple modalities for reminders (audio, visual and phone/text alerts) and features cellular technology to connect caregivers to individuals in the home or care setting. There is no need for a wireless connection or phone line for use and a battery backup system improves portability.
The MedMinder dispenser box can be set up either through manual filling by a caregiver, or through convenient insert trays that can be filled by a pharmacy. Each tray within the dispenser provides anywhere from one to four weeks of medication, depending on the amount and frequency needed. The user interface has no buttons or complex settings for users to manage. Each dosage “cup” can house up to 20 pills of various sizes and can be easily removed, even by individuals with physical challenges due to conditions like arthritis.
Once the MedMinder system is connected, the setup process for alerts can be done quickly by phone or through a web portal. The device is designed to support a variety of complex medication regimens and can be updated at any point when a medication protocol is modified. After programming, the MedMinder dispenser provides escalating reminders at the time that a medication is due to be taken. The sequence of reminders is also completely customizable. For example, an individual may want to receive a flashing light reminder, and then an auditory reminder and finally a phone call if the medications are not taken in a timely fashion. The system’s remote database then tracks whether the dispenser is opened at the appropriate interval and this information can be used to notify caregivers and loved ones via phone or text message.
Flexibility and convenience can deliver proven results
Since its inception in 2008, MedMinder has tracked an average adherence rate of 92% for users of its system. To better understand baseline adherence rates and demonstrate effectiveness of the device, the company also initiated a six-month academic pilot program in 2011 The pilot tested a hypertensive population of seniors through a partnership with a New York based Veteran’s Administration health system.
To initiate the study, baseline results were collected over a three-month period for both the control and intervention groups. During this timeframe, participants utilized the Medminder system so that accurate compliance data could be collected and analyzed, but the device’s reminder functionality was disabled. The baseline results revealed that medication adherence rates were found to be in the 50-60% range in the absence of reminders. This data corresponds with average adherence rates validated by a variety of prominent research studies published in peer-reviewed journals. After the three-month baseline period, only the intervention group then began receiving the visual, auditory and phone/text alerts for another three-month period to determine the effectiveness of these reminders. After the MedMinder alerts were put into place, medication adherence rose dramatically to 90-100% in the control group population.
“It was amazing to observe just how few individuals correctly follow their medication regimen without the use of our reminder system,” said Eran Shavelsky, MedMinder CEO. “Once the alerts were activated, we saw not only increased adherence rates but also qualitative results that showed individuals felt dramatic improvements to their peace of mind and quality of life”.
Enhancing adherence through connectivity with caregivers and providers
In addition to the reminder functionality, the MedMinder product can also connect multiple caregivers and/or health professionals with important information about an individual’s medication adherence. Caregivers and providers can subscribe to weekly reports that summarize the patient’s medication activities for that week. Those who monitor multiple patients can also choose to receive aggregative notifications and reports. This data may reveal patterns of non-adherence or provide opportunities for patient education to improve medication management. For example, if an individual has difficulty remembering to take their evening medication, additional support or changes to the medication schedule may be warranted.
Partnering with organizations to drive healthcare quality
MedMinder currently distributes its medication management tool through a variety of channels, both direct-to-consumer and through health plans, hospitals, health systems and employer groups. Blue Cross Blue Shield of Arizona, a MedMinder customer, has seen impressive early results from its use of the technology. This non-for-profit health plan has provided the product to a variety of populations, including its own employees.
“I have seen firsthand how this product is helping individuals take control of their own health and live more independently while reducing the need for hospitalizations and nursing home dmissions,” said Dr. Vishu Jhaveri, Chief Medical Officer and Senior Vice President at Blue Cross Blue Shield of Arizona. “It is also improving the lives of caregivers who feel reassured that they can stay connected and involved in the care of their loved ones”.
Providing peace-of-mind to users and loved ones
Consumers who utilize MedMinder technology have also cited its ease of use and effectiveness. Whether purchased by a loved one or directly by an individual concerned about their inability to follow medication as prescribed, MedMinder provides a relatively affordable option for most users. A low monthly subscription fee includes the use of all equipment as well as access to reporting and connectivity for unlimited caregivers, family members and medical professionals.
MedMinder can allow its users to maintain greater independence and quality of life by preventing the potential health consequences of non-compliance and providing additional peace of mind to loved ones.“
My Dad is 80 and had been in and out of the hospital in 2010 because he took his medications incorrectly,” according to one individual who purchased the product. “ MedMinder has helped him live independently—and in better health—with no hospital visits required”.
Looking to the future of medication management
New technology, electronic patient records and data-driven medical management strategies are all transforming the way that care is delivered for patients with chronic conditions. Medication management solutions that provide valuable clinical insight while improving adherence will be an important part of this new era of patient care.
Tools like the MedMinder system can also drive greater connectivity between patients and healthcare professionals while supporting quality-based care initiatives to help reduce hospital admissions and prevent costly, unnecessary interventions. Perhaps most importantly, these systems will help engage individuals and empower them to take control of their own health and healthcare decisions.
- Heneghan CJ, Glasziou PP, Perera R. (2008) Reminder packaging for improving adherence to self-administered long-term medications (Review). Cochrane Database Syst Rev. 2006 Jan 25;(1):CD00502
- Winterstein AG, Sauer BC, Hepler CD, Poole C. (2002) Preventable drug-related hospital admissions. Ann Pharmacother.36:1238-1248
- Leenderste AJ, Egberts AC, Stoker LJ, van den Bemt PMIA for the HARM Study Group. (2008) Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch. Intern. Med. 168: 1890-1896
- Lewington S, Clarke R, Qizilbash N, Petro R, Collins R (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360:1903-13
- Farris, KB, Phillips, BB (2008) Instruments assessing capacity to manage medications. The Annals of Pharmacotherapy 42: 1026-1036
- Lewis A. (1997) Nonadherence: a $100 billion problem. Remington Report 5:14–15
- M.C. Roebuck et al. “Medical Adherence Leads to Lower Health Care Use And Costs Despite Increased Drug Spending.” Health Affairs, January 2011.
- American Heart Association, op cit and CDC and Merck Institute of Aging and Health, “The State of Aging and Health in America 2004”
