The health care industry has a $300 billion problem: nonadherence to prescribed medications.
Nonadherence has many potential causes. Some patients don't fill prescriptions because of concerns about drug costs. Some take medication inconsistently or at the wrong dose. And some choose not to follow their doctor's orders out of laziness, distrust, or an aversion to side effects.
Patients who do not take their medication as prescribed could risk costly hospitalization—or even death. But while there does not appear to be a simple solution to the problem of nonadherence, the good news is it's highly preventable.
Health care providers are looking to new digital health tools to improve patient interaction and engagement—holding patients accountable for their health outside of the hospital or doctor's office. By leveraging new technology (e.g., sensors, mobile apps, predictive analytics), both health providers and patients can track behavior, proactively modify treatment regimens, and have more collaborative exchanges during visits.
There are a number of IT vendors trying to fill this need, using slightly different tactics:
Proteus Digital Health offers its Proteus Discover system, which includes ingestible sensors that record data about medication management and adherence. A sensor is placed inside of a pill, and once consumed, sends a signal to an adhesive patch worn on the body (which can also track sleep patterns, steps, heart rate, and other health metrics). The patch then sends a digital record to a mobile app and a web-based portal, where patients and caregivers can access dashboards to track progress, modify treatment, or intervene as needed. Proteus has tested the device in partnerships with Texas-based Children's Health, and California-based Barton Health. More recently, FDA approved a joint application from Otsuka Pharmaceutical and Proteus to prescribe a sensor-enabled antipsychotic drug called Abilify MyCite, making it the first FDA-approved digital pill.
Another vendor, AICure, uses artificial intelligence (AI) and a mobile app to track medication adherence. First, the app when opened identifies the patient using computer vision technology. Once verified, the patient shows the medication to the device's camera, allowing the app to identify the drug and confirm ingestion. The app then relays this information to a web-based dashboard for the care team to review and monitor the patient's adherence patterns in a way similar to Proteus' system. AICure is being used in a number of clinical trials and population health studies, and has received multiple innovation grants from the National Institutes of Health (NIH) since its inception in 2010.
Lastly, there is Catalia Health, which developed an AI-powered companion robot called Mabu to engage with patients at home and help them comply with their care plans. The robot, which is small enough to sit on a desk or counter, interacts with patients via a built-in tablet using natural language processing and behavioral psychology, adapting to the user's preferences over time. Mabu can also send messages to a mobile device. These daily interactions collect data about the patient, which is then sent to a cloud-based platform for providers to monitor. In addition to giving patients their daily medication reminders, the robot can also evaluate patients' emotional state, provide general wellness tips, or contact care providers if needed. Catalia is testing Mabu in ongoing pilots with health systems, pharma companies, and home health organizations.
These three vendors represent only a fraction of the options available to health care providers. However, while they offer intriguing solutions to nonadherence, there are new challenges to consider:
- Patients may not always have access to smartphones when taking medication;
- Ingestible sensors may not activate properly once consumed, or the signal may be delayed;
- Body patches can sometimes not fit properly (e.g., on younger children);
- Although FDA has approved Abilify MyCite, it still needs proof that such smart pills can improve patient compliance;
- Costs for these new methods are still uncertain, and insurers will need further evidence before they start covering them;
- The introduction of sensors, AI, and other means of tracking will inevitably lead to privacy and security concerns for patients; and
- It is still unclear if any of these new approaches can address the multi-variable aspect of medication nonadherence.
Despite these challenges, these IT vendors are providing new options to reach patients in their daily lives. There will not be a "silver bullet" solution for medication adherence, but the problem will likely improve through a combination of technology and behavioral psychology that takes individual patient needs and circumstances into account. Read our Daily Briefing article to review five root causes of nonadherence and best practices health systems should consider to address them.
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