Medication Adherence Technologies: Promise or Pitfalls?

Historically, most cancer treatments have been administered in oncology offices or hospitals, but oral medications are becoming increasingly common, and oral formulations of chemotherapy, targeted therapies, and hormonal therapies are available. While oral medications are a welcomed addition to the oncology arsenal because they allow patients to avoid time-consuming and costly office visits, they also require patient compliance to ensure benefit is derived. Studies have shown that non-adherence to oral regimens not only leads to a lack of effect, but can result in increased office or hospital visits and longer hospital stays secondary to complications or disease progression. Further, when patients do not adhere to their prescribed drug regimens, any variability in therapeutic effect may be attributed to a lack of efficacy of the drug, which may result in discontinuation of a potentially useful treatment or even a whole class of agents.

There are many reasons why patients with cancer do not adhere to their oral therapy regimens. Some patients simply forget to take their medication, whereas others fear the side effects or want a break from treatment. Because some oral antineoplastic therapies can result in considerable adverse events, skipping treatments may be especially tempting for patients with cancer. In other cases, cost concerns may be a factor, or there may be complex dosing schedules to contend with, leading to confusion. Fortunately, numerous technologies are available to help patients stick to their treatment regimens. Available technologies include everything from standalone devices such as smart pillboxes to apps that use the iPhone and other platforms to send e-mail alerts and text messages, and even make phone calls to ensure patients take their medication. While these technologies do not solve many compliance issues, such as cost, lack of social support, or fear of adverse effects, they can still play an important role in keeping patients compliant by being part of a multifaceted strategy to improve adherence to oral antineoplastic agents.

Standalone devices

Countless standalone devices are available to remind patients to take their medicine or help them keep their pills organized, including high-tech pillboxes and organizers, watches with vibration or alarm reminders, and medication timers. Standalone devices may be especially appealing to older patients or those who do not have a smartphone or are not tech savvy. Newer standalone devices, such as the Maya Pill Dispenser, not only remind patients to take their medication, but also generate compliance reports, allowing medication adherence to be tracked with greater accuracy.

Maya Pill Dispenser

Although MedMinder Systems’ Maya pill dispenser resembles a 7-day pill organizer, it is no ordinary pillbox. This 28-compartment, high-tech dispenser comes equipped with wireless technology that sends updates to MedMinder’s central computer about the patient’s dosage activity, which can be viewed online; however, the patient’s home does not require a computer, phone line, wireless router, or any other form of Internet access to monitor this activity. The system features a friendly interface with no digital readouts or buttons, and is programmed remotely via the Internet or through MedMinder over the phone. Once Maya is set up, it can provide both patient reminders and activity monitoring. Reminders include the appropriate pill compartment flashing, and if the medication cup is not removed from the tray within a designated timeframe, there are auditory prompts, automatic phone calls, text messages, and e-mails, depending on how the system is programmed. The patient’s activity log can be viewed online by caregivers and healthcare providers, and the system can be programmed to send real-time email or text message notifications or weekly email reports. Patients or their caregivers can manually refill the trays, or MedMinder-supplied trays pre-filled by a pharmacist may be used instead. The latter option may be especially useful for patients on complex regimens, as it reduces confusion and the risk of medications errors. In addition, if the wrong medication cup is taken, the system sounds an alert, ensuring patients take the correct medication. More information on the Maya, including a video demonstration, is available at www.medminder.com. The Maya pill dispenser can be purchased through Amazon at http://amzn.to/arftM1, where it retails for $395, which includes a 1-year subscription.

Apps

Some studies have shown that e-mail alerts, phone calls, and text message reminders can improve adherence to prescription medications, leading to better outcomes. Patients who are tech savvy and have smartphones may prefer an app, which provide these features and is a far less expensive compliance solution, costing just a few dollars. Apps also allow greater flexibility in terms of which treatments are tracked, allowing reminders to be set for topical and over-the-counter therapies, and may enable other important information to be recorded, such as side effects.

Personal Caregiver

Personal Caregiver, developed by iMedic8 Manager, LLC, is available for both healthcare providers and patients, with three versions available. Both patient versions remind patients to take their medications, alert them when refills are needed, and warn of adverse drug interactions. The Personal version, which costs $1.99, allows one non-expiring profile, whereas the Premium version, which costs $2.99, allows up to three non-expiring profiles. The Premium version also provides more detailed medication information, has prioritized label warnings, and provides instructions on what to do if a dose is missed. The Professional version, intended for healthcare providers, costs $3.99 and allows up to 16 profiles to be managed, but providers are charged a per-year fee for each profile. The Professional version includes all the features of the Personal and Premium versions and provides a drug database that includes over 17,000 prescription drugs, over-the-counter medications, and herbal supplements. The app is available for download at Apple’s App Store. To see a video of the app in action, visit www.personalcaregiver.com.

MedsLog

MedsLog helps patients remember which medications to take and when to take them. It also keeps a log of past consumptions and allows patients to schedule items such as eye-drops, creams, or ointments, which may be useful for oncology patients who are prescribed topical therapies or use topical treatments to combat treatment-related side effects such as dry skin. In addition, patient logs can be used to record vital statistics such as blood pressure and general information on the patient’s condition. The activity log can show an individual’s vital statistics at the time the medication was taken, which may be useful in determining if there are any trends in the event the patient is noncompliant. While MedsLog does not automatically send a copy of the user’s activity to their pharmacist or physician, the patient or their caregiver can e-mail this information to the clinic or pharmacy as needed. The app is available at the Apple App Store for $2.99 at http://bit.ly/bFgCdj.

Using a Multifaceted Approach

According to a New England Healthcare Institute report (http://bit.ly/xlZaW), poor medication adherence results in about $290 billion in added medical spending annually. This costly problem has led many companies and entrepreneurs to develop novel solutions. While these may be able to keep some patients compliant, especially those whose only problem is remembering to take their medication, they may not help individuals who skip doses to cut costs or want a break from the side effects of treatment, which are common dilemmas faced by patients with cancer. As a result, oncologists may need to take more time than other physicians and specialists to understand compliance barriers in patients on oral treatments and strive to develop more personalized strategies in aiding compliance. Use of compliance technologies, such as compliance apps and smart pillboxes that generate adherence reports, may serve as an integral component, as these technologies record trends, allowing potential barriers to be identified. Once barriers are noted, it may be easier to work with patients to overcome them; however, until a technology is developed that can guarantee a patient is actually swallowing his or her pills, compliance will remain a bitter pill for the healthcare system.