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Mission Impossible: How to tell if your patients are taking their medications

As a pharmacy student, I’ve been drilled rigorously that medication adherence is a vital cornerstone to effectively treating patients and achieving positive clinical outcomes. Yet with so much emphasis dedicated to ensuring that patients are taking their medications, it is estimated that approximately 20-50% of patients are non-adherent. With such high numbers of patients not adhering, it is crucial that pharmacists find tools and strategies to monitor and improve adherence.

The simplest way to find out if a patient is taking a medication is to ask.  There is a simple 4 question assessment to better gauge whether or not patients take their medications. This scale, the Morisky scale, allows for pharmacists to not only interact with their patients, but also allows him to ‘score’ the interaction and get a better idea of their patient’s compliance. A study using the scale observed that if a patient was found to be compliant, there was a 93% chance that they were indeed compliant (high sensitivity). But the study does lack specificity as indicated by the finding that if a patient was found to be non-compliant, there was a 53% chance that that was indeed the case. The Morisky scale is a great tool to use when interviewing a patient, but again, the low specificity leaves a level of ambiguity.

A more direct, but still primitive method of determining patient compliance is a pill count. While the method is simple, the accuracy of the information gathered is directly dependent on the patient.  Unfortunately, patients could manipulate the number of pills in the vial and you still aren’t certain whether the medication is being taking as directed.  However, one study showed that unannounced pill counts by phone improved compliance in AIDs patients and this method could feasibly be applied to other realms of practice.  While pill counts are an acceptable first line of defense against non-compliance, more advance methods are available.  

With the level of automation in pharmacy nowadays, digital records of refill and prescription pick-ups are simple to compile and interpret. A pharmacist can easily access a patient’s records and observe their refill habits.  It can be determined if the patient is picking up their medications on time and in line with when their quantities should be depleted if the drug is being taken as directed. But as with the pill count, the use of a pharmacy record is limited. The patient could be using multiple pharmacies and the patient’s actual habits cannot be assessed by simply looking at when they come in for a refill. Records are important, but what if a doctor or pharmacist could actually verify the exact time when their patient takes their medication?

The future of medication adherence monitoring could come in the shape of a digital pill. A transmitter the size of a grain of sand can be embedded inside a pill which then can send a text, email, or  tweet to the patient/health care provider when it was taken. This technology could do wonders for patients with high risk disease states like cancer or HIV. While this sounds like science fiction, Proteus Digital Health claims that this incredible technology will be available to
drug companies within the next three years.  

While it seems like a daunting task at times, medication adherence monitoring is an important aspect of what we do as pharmacists. By utilizing the tools discussed, we should be able to improve ompliance and make a positive impact on patient outcomes.

Mackenzie F. Blair, PharmD '15


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