Experts | University of the Sciences

Forecasting Medication Non-Adherence: A Profitable Approach That Helps Patients

$290 billion a year—a study by the New England Healthcare Institute found this to be the amount spent in the United States as a result of medication non-adherence and other avoidable issues. An analysis by Capgemini Consulting estimated that $188 billion account for pharmaceutical industry losses in the United States for the same reason. With such considerable monetary losses in addition to the health risks associated with non-adherence, the profitable future for health information technology (health IT) is becoming increasingly apparent.

After recognizing the significant financial costs associated with non-adherence, many insurance providers are utilizing new initiatives based on health IT that aim to predict non-adherence in an effort to proactively address the issue. In early 2011, CVS Caremark introduced its Pharmacy Advisor™ Program, which pays special attention to patients with chronic conditions like diabetes, who are likely to be non-adherent.  In April of 2012, Express Scripts^® launched a similar predictive tool called ScreenRx, which detects risk for medication non-adherence and then subsequently provides personalized interventions for those patients. Additionally, companies like RxAnte^© and Allazo Health^© apply behavioral science, predictive analytics and claims data to formulate algorithms that will allow them to determine which patients would be at an increased risk for non-adherence. They then take it a step further by tailoring interventions according to patient characteristics.

So since there’s no magic crystal ball one can look into to predict medication non-adherence, how do these companies determine who to monitor and intervene with? The key to the above-mentioned initiatives is the incorporation of patient behavior in forecasting non-adherence.

One commonly used model in analyzing health behavior is the Health Belief Model (HBM). This model explains that a patient’s behavior when it comes to health is motivated and influenced by varying perceptions. In essence, the HBM finds that perceived susceptibility, perceived benefits, perceived barriers and perceived seriousness all contribute to decision making when it comes to health, which in this case, would be in reference to taking their medications.

So how relevant is patient behavior when it comes to medication non-adherence? Express Scripts^® found that 69% of medication non-adherence was attributed to patient behavior factors including simple procrastination and forgetfulness. With even more advancements in health IT, providers will be able to dissect and rationalize reasons for non-adherence and further analyze patient behavior to formulate optimal regimens that will save billions of dollars all while promoting better health outcomes.

 Anita A. Pothen, PharmD’14

Drugs Don’t Work in Patients Who Don’t Take Them

These are the words of former U.S. Surgeon General C. Everett Koop. While the concept is simple, practitioners have been researching and implementing innovative methods to get the point across. Before we look at this, let’s first define the terms.

Adherence, persistence, and compliance—in reference to patients taking their meds, these all mean the same thing right? Not necessarily. These seemingly synonymous words have their distinct differences and varying methods of measurement that should be considered. Simply put, compliance is represented by a percentage of doses taken as prescribed in respect to timing, dosage and frequency. On the other hand, persistence counts the days a patient has had their medications over time. If a patient is considered persistent, we can confirm that they have been taking their medications for “x” number of days. What we do not know is if they are adherent. Just because a patient is persistently taking their medication, we cannot assume they are following the regimen from their doctor. Adherence suggests that a patient sticks to their drug regimen as prescribed with respect to the drug, dosage, and frequency. Sounds like compliance right? While the terms are similar, compliance has a more passive connotation whereas adherence aims for a coordinated effort between the doctor and patient.

In particular, adherence can be cumbersome for patients who have suffered a myocardial infarction. Seeing that less than 50% of patients follow their heart medications as prescribed, the University of Pennsylvania Health System was awarded a grant from the Centers for Medicare and Medicaid Services that aims to improve adherence in these patients with an estimated savings of over $2.7 million over 3 years. As an incentive, patients are able to win money based on a lottery system with the caveat being that the patient must have had taken their medication the day before in order to be eligible. This will be determined by electrical signals sent from the bottle to the doctor, which seems similar to devices like MEMS^TM products. If patients do not take their meds, they risk not receiving a cash reward. By incentivizing compliance with partial reinforcement, researchers may make taking medications a little more enticing.

While this is only one approach, it is the overall goal of this study as well as many others to stress the importance of adherence, even if it means incorporating positive reinforcement. As indicated by the collaborative connotation of the word, the success of adherence lies on the input from the provider and the motivation of the patient.

Anita A. Pothen, PharmD ‘14

Medication Adherence—There’s An App For That Too!

Medication adherence has been a topic of interest for health care providers, caregivers and third-party providers alike. While practitioners work hard to select optimal drug therapy for their patients, clinical improvements may not always result as expected. This inefficacy in treatment often stems from the inability of patients to adhere to the treatment regimens set forth by providers. While many patients struggle to adhere to their  regimens for a number of reasons, technology-centered initiatives like the MediSafe^© Project are taking advantage of the utility of smart phone applications to steer consumers towards better adherence. MediSafe^® allows patients to scan drug barcodes, add directions and set alerts so that they are reminded to take them in a timely manner. If patients still fail to take their medication on time, the app can be synced to a loved one or caregiver so that they are alerted that the patient did not follow the regimen as indicated. iPharmacy^© is another app available at no cost that offers additional features along with medication reminders.  Some of these tools include a pill identifier, access to information pertaining to drug recalls and a pharmacy locator.

So what if the patient is not particularly keen on the idea of using a smart phone? After all, widespread popularity with smart phones lies predominantly with younger generations. While MediSafe^© in particular is working towards improving accessibility by implementing low-tech solutions, there are additional options already in place. EMMA^®, (Electronic Medication Management System) is an in-house, FDA-approved comprehensive management system for patients with complex medication regimens. EMMA^® houses blister cards of medications that are inserted into the machine like compact discs and can be remotely controlled by pharmacists. The system collects more accurate adherence information, which pharmacists and physicians can access. Though this technology provides considerable accuracy in adherence measurement, it is not a guarantee that all patients will be eligible for coverage and thus may not be able to afford the machine.

While all these approaches differ in one way or another, there is a common theme—improvement in adherence by means of a more involved and integrative strategy that aims to bridge the gap between practitioner initiatives and patient implementation. While finances and the adaptation of the senior population to advances in technology remain as limitations, there is a great deal of progress, such as NCPIE’s National Action Plan that paves the way for better adherence and ultimately, better health outcomes.

Anita Pothen

Pharm.D Candidate 2014

New Medication Bottles and Labels Improve Patient Compliance/Adherence

So does a new and improved label for a prescription bottle really improve patient compliance?  Similarly, does a flattened (versus a round) bottle make a patient take their medication more consistently? Would having all medications packaged in a blister pak alleviate the ailment of medication forgetfullness?   This Wall Street Journal article suggests that it does.  In fact, the research it points to does show that there is improved medication taking behavior.  But hold on, for those patients on multiple medications multiple times a day, would having 5-10 different sets of blister packs really help?  It might, but then again so would a well designed pill box with the days/times labeled and a translucent cover so that you can see if the medications were taken or not fairly readily.  These inexpensive boxes are reusable and do not increase the carbon footprint already associated with medications. 

As for the improve labels and bottles that are more easily readable - I am all for it!  As my eyes tire from writing this blog, I can only imagine how difficult it is to read the label on an 8 dram (very small) prescription bottle that is only ~2 inches high. 

My recommendation to anyone who takes a medication - be sure to incorporate it into your daily life - leave it near your toothbrush or take it with your meal (if OK with your pharmacist) or leave it by your bedside.  And if you need help on how to take your medication, ask your pharmacist. 

Alzheimer’s Disease: Tips to Ensure a Meaningful Holiday Season

The holiday season is a time of togetherness where families and friends gather to celebrate and give thanks. When a relative or family friend experiences memory loss associated with Alzheimer’s disease, however, Thanksgiving dinners and holiday gatherings can be particularly trying.  

“Family members may be unsure of how to approach a loved one who experiences memory loss, repeats conversations, forgets members of the family, and is confused,” noted Dr. Stephen Moelter, associate professor of psychology at University of the Sciences. “This can cause family members to feel uncomfortable.” Dr. Moelter believes that adults and children alike can arm themselves with ways to engage people with memory difficulty to ensure a more meaningful holiday season.  

• Family members must educate themselves about Alzheimer’s disease.  Learning more about the disease will help family members understand the importance of keeping their loved one safe and surrounded by supportive people. Helpful information can be found on the Alzheimer’s Association’s website www.alz.org, while younger children may benefit from videos such as HBO’s “Grandpa, do you know who I am?” available online at www.hbo.com/alzheimers.
  
  
• Engaging people with Alzheimer’s in conversation and keeping them involved in activities is vital to their health. Dr. Moelter suggests that conversation should be at the level of the loved one and it is ideal to let them lead. Fundamentally, although it may sometimes seem unusual, family members should know that it is okay to answer repeated questions with the same answers. “What matters most is that we answer with interest and a positive tone and understand that it is not helpful to question the person about the memory problem or to challenge them to remember,” added Dr. Moelter. Challenging the person with Alzheimer’s can lead to increased anxiety and may make memory, cognition, and behavior worse. Such challenging or “testing” of your family member will not help them to remember more.
  
  
• When speaking, family members should try to ask questions that rely on “old knowledge” and encourage reminiscing about holidays past. In general, people with memory problems have the best memory for distant events with more impairment as the people and events to be recalled become more recent. For instance, it may be easier for the person with memory problems to talk about the holidays when they were a child or young adult compared to a more recent holiday.
  
  
• Parents should prepare their children for conversations and can help by offering suggestions of things to ask their family member. Topics may include those that parents know are strong and positive and old memories such as hobbies, jobs, or family events. “Alzheimer’s can be especially challenging for children to comprehend,” admitted Dr. Moelter. “It is important parents understand this and give younger children permission to keep interactions brief if they feel uneasy.”

Research Day Showcases Faculty and Student Research

From metabolic engineering to computational chemistry and from structural prediction of proteins to rational design of new therapeutics, University of the Sciences in Philadelphia showcased the diversity and growth of research pursuits on campus during its 7th Annual Research Day starting on Thursday, April 2, 2009. Posters representing approximately 120 topics were on display.

Research Day recognizes undergraduate and graduate student research efforts, and highlights aspects of faculty scholarly activity to encourage and promote communication and collaboration among investigators. The University is distinctive in that most undergraduate students conduct research with faculty early in their academic careers.

The diverse research activity on display spans several aspects of the University’s scholarly pursuits, including:

• Biological Sciences: Dr. Jennifer Anthony’s research involving the metabolic engineering of E. coli for the production of vitamin A.
  • Chemistry: Dr. Randy Zauhar’s use of computer-aided drug design to identify new antimicrobial lead compounds.
• Pharmaceutical Sciences: Dr. Bin Chen’s evaluation of the effects of vascular-targeting photodynamic therapy on prostate cancer metastasis.
• Physical Therapy: Dr. Therese Johnston’s usage of treadmill training for children with cerebral palsy.
• Social Sciences: Psychology major Mark Paullin’s (Philadelphia, Pa.) study of mild cognitive impairment in Alzheimer’s disease.
• Health Policy: Master in public health major Sekinat Kekere-Ekun’s (Deptford, N.J.) work on the descriptive epidemiology of viral hepatitis in methadone maintenance clients.
• Pharmacy Practice: Doctor of pharmacy students Neha Patel (Fairless Hills, Pa.), Puja Patel (Hillsborough, N.J.), and Isha Shah’s (Bensalem, Pa.) analysis of the usage of ondansetron in non-chemotherapy patients at a community teaching hospital.