Technology Can Improve Medication Adherence Rates, Management

Technology can help drastically improve disease monitoring, management, and diagnosis, according to a study presented at the virtual 2020 American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting and Exhibition.

Wearable technology and apps that monitor health and wellness have exploded in popularity and sophistication in recent years. According to presenter Betsy Cernero, PharmD, an ambulatory care clinical pharmacist at New York-Presbyterian Hospital in New York, New York, the 21st Century Cares Act promotes the accelerate development, approval, and review of such products while HIPAA applies to information that is transmitted or stored on apps and devices.

“Digital medicine and its regulation are constantly evolving, which is a great thing,” said Cernero.

One area that has seen tremendous benefit from digital health technology is cardiology. Self-blood pressure monitors such as iHealth can be purchased for $40 to $80. iHealth is able to detect an irregular heartbeat and is wireless, according to Cernero. Devices like iHealth can also monitor patient adherence. Any blood pressure self-monitoring device should be certified by either the Association for the Advancement of Medical Instruments, the British Hypertension Society, and the European Society of Hypertension.

In the diabetes space, continuous glucose monitors have grown increasingly sophisticated, with many of them connecting straight to a smartphone or other handheld device. Currently, 34.2 million people have been diagnosed with diabetes in the United States, while another 7.3 million people go undiagnosed. In 2017, diabetes was the seventh leading cause of death in the US. Total direct and indirect cost of diagnosed diabetes is estimated to be $327 billion.

Wearable devices that monitor our health aren’t the only medical tech making massive strides. Wearable devices that administer medication have also been gaining ground. Patients adhere to 50% of the drugs prescribed for chronic disease in developed nations, according to presenters. Wearable drug delivery devices, sometimes called bolus injectors or on-body infusers, can help increase medication adherence, according to Cernero.

The technology has proved especially beneficial for those living with cancer. For example, in 2015 the FDA approved a device for pegfilgrastim that decreased the incidence of infection in patients with non-myeloid malignancies who are receiving myelosuppressive anticancer drugs that are associated with a clinically significant incidence of febrile neutropenia. The device is a single-use-on-body infuser with a prefilled cartridge. The provider loads the device, which delivers a 45 minute at home self-injection approximately 27 hours after application.

Despite the benefits of wearable medication delivery, barriers do exist. Patients may be confused by how they work, and they are often expensive. Additionally, all the factors relating to medication adherence are not fully addressed in most applications. A reliance on self-reporting may also impact results.

According to presenter Carolyn J. Oxencis, PharmD, BCOP, a clinical oncology pharmacist and clinical assistant professor at Froedtert and the Medical College of Wisconsin, in Milwaukee, Wisconsin, a lack of integration into electronic health records also exists. Low income patients or patients with low health literacy may also not have access to these devices.

“So, barriers to using any of these apps, of course, is… ease of use and cost,” Oxencis said. “What do these apps look like, and are they actually helpful?”

Technology and medicine have continued to merge in recent years, and the regulations surrounding them also continue to evolve. Pharmacists should integrate mobile health application in their routine clinical practice for maximum optimization, the presenters said.

REFERENCE

Cernero B, Oxencis, C. Don’t Worry, Be “Appy”: When Tech Meets Medicine. Presented at: 2020 ASHP Midyear Clinical Meeting and Exhibition; virtual: December 9, 2020.