Strategies and Tools for Promoting Medication Adherence

Medications work only whenpatients take them as prescribed.Unfortunately, patientsvery often skip doses or take themat the wrong time. Nonadherence ratesaveraged 71% and ranged as high as 97%in >70 studies where patients' dose takingwas monitored electronically. Similarly,a review of 14 studies of patients' dose timing showed that <41% of peopleconsistently self-administered prescriptiondrugs on the schedule set by theirprescriber.¹ Elderly patients and thosewith serious psychological problems—the very patients who are most at risk forsuffering adverse consequences frompoor medication adherence—are particularlylikely not to follow dosing instructions.^2,3

Individuals' reasons for failing to takemedications appropriately vary. Patients,however, appear most prone to be nonadherentwhen:

• They are taking several differentmedications and multiple doses perday
• They must refill prescriptionsfrequently
• They have trouble affording theirdrugs

Pharmacists can work with patientsand prescribers to mitigate each of thesefactors by:

• Simplifying drug regimens
• Arranging for 90-day supplies
• Suggesting substitutions of lowercosttherapeutic equivalents forexpensive brand name products⁴
• Educating patients about how theirmedications work
• Instructing patients on how toadminister doses
• Following up with patients onwhether they are using their drugsand whether they are experiencingany problems^5,6

In addition to these strategies, a broadarray of tools and devices is available topromote appropriate drug-taking behaviors.Adherence packaging demands themost from pharmacists but can offerpatients great benefits in terms of convenienceand drug information. Dosingalarms are desirable for patients whomust take different medications at differenttimes each day. Pill organizers canhelp patients adhere to complex therapeuticregimens. Briefdescriptions of examplesof each type ofadherence aid follow. For best results, counselingand followup should be combined with patients' useof adherence aids. Although research has shown mixed results from the simpleuse of pill organizers, it has consistently demonstrated that appropriatedrug use increases when multifacetedapproaches to adherence are employed.^3,7

Adherence Packaging

Sending patients home from the pharmacywith their medications presortedinto batches as they are meant to betaken can go a long way toward reducingthe number of missed and mistimeddoses. For example, software and blisterpackagingsystems from Medicine-On-Time (www.medicine-on-time.com) canhelp achieve this goal.

Patients who receive their prescriptionsfrom pharmacists using Medicine-On-Time receive a calendar card that haspockets filled with the tablets they needto take together. The cards come in varyingsizes, and the pockets can be filledaccording to the day or time. Each of thecards and individual pocket seals can belabeled with the name(s), dosage(s), andspecial instructions for their contents, aswell as with the patient's name andother relevant information.

Adherence packaging can be offeredto patients for a fee. It also is a valuableservice for assisted living facilities andhospices that lack in-house pharmacies.

Dosing Alarms

Numerous wristwatches, pagers, andtimers customized to sound alarmswhen it is time to take medications areavailable. Most can be programmed tosound several times each day; somewatches can sound 30 different alerts.Users typically can choose betweenaudio and vibrating alarms.

A more advanced dosing-alarm systemis available from OnTimeRx(www.ontimerx.com). Patients who usecomputers or personal digital assistantscan download OnTimeRx and use theprogram to keep track of their medications and other health information. Theprogram lets patients enter the names,doses, regimens, and warnings for alltheir medications, set dosing schedules,receive alerts when it is time to takedoses or request refills, and keep recordsof their drug taking. In addition,OnTimeRx lets patients record and regularlyupdate their medical history.

The company that developed On-TimeRx, AmeliaPlex, also offers personalizedvoice and e-mail medication reminderservices. Patients who registerfor OnCellRx type in the messages theywish to receive and specify the daysand times when they wish to havethose messages delivered. The messagescan be as detailed as thepatients need them to be, and they aresent to patients' e-mail or telephone atthe times requested.

Pill Organizers

Pill organizers can be as simple asboxes with bins labeled for days of theweek or as complex as automatic dispenserswith alarm and drug informationdisplay functions. Patient characteristicsand preferences, as well as the numberand kinds of medications a patient is taking,should guide the selection of a pillorganizer. A 35-year-old patient taking astatin and a multivitamin each day probablyneeds nothing more than the mostbasic organizer. A 75-year-old being treatedfor diabetes, early-stage dementia,and glaucoma, however, would be betterserved with an organizer that featuresprefilled dosing cups, reminder alerts,and locks to prevent access to medicationsuntil it is time to take them.

The many options for pill organizers,along with descriptions of their features,can be reviewed online at www.epill.comand www.forgettingthepill.com. Thesesites also offer several types of standalonemedication alarms.

Mr. Lamb is a freelance pharmacywriter living in Virginia Beach,Va, andpresident of Thorough Cursor Inc.

For a list of references, send a stamped,self-addressed envelope to: ReferencesDepartment, Attn. A. Rybovic, PharmacyTimes, Ascend Media Healthcare, 103 CollegeRoad East, Princeton, NJ 08540; or send an emailrequest to: arybovic@ascendmedia.com.