Tackling medication adherence

BOSTON—Medication adherence remains a prevalent problem, but technology and data can be leveraged to influence patient behavior so they better manage their health, according to a panel of speakers at the mHealth +Telehealth World Congress 2013 .

“The sense of possibility we have today did not even exist two years ago. New mHealth technologies fit well into solutions to improve medical adherence,” said Tom Hubbard, vice president of policy research, National Institutes of Health, who moderated a panel on the topic.  

Kevin Hommel, PhD, research associate professor of pediatrics, Center for the Promotion and Treatment Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, reported high levels of noncompliance, which he defines as patients taking less than 8 percent of their medications. He said about half of adults and children (under 12) are noncompliant, with 88 percent of adolescents failing to adhere to medications.

Complex psychological reasons are at the root of failure to comply. Mental illness and cognitive decline all interfere with the ability of medication, he said. “Education alone is not sufficient. We have to do a behavioral intervention,” he said. “Things like texting, gaming apps and telehealth can be helpful.”

Aunia Grogan, chief executive officer of Atlantis Healthcare, said the reasons for non-adherence cannot be generalized and vary from person to person.

Patients claiming they forgot to take their meds have really, on an internal level, made a decision not to comply, she said. For instance, patients with asthma often do not take medications unless an asthma attack happens. “They don’t see it as a chronic condition.”

At Atlantis Healthcare, they built a patient adherence program that leverages technology to work with patients on an individual basis. The patient enrolls, fills out an individual profile that addresses their medication beliefs, illness beliefs, self-efficacy, motivation and unintentional non-adherence. Then they personalize the content and frequency of messages they want to receive and through what platform (text, web portal, nurse calls, etc.)

She said mHealth is critical for Atlantis Healthcare in two areas: at enrollment, when gathering information to drive personalization; and during the actual intervention.

At all times, the patient must remain center of the adherence strategy, she said, noting that it has to be integrated into how the user lives his or her life. “The significant thing is to put yourself in the patients’ shoes.”

Tom Olenzak, innovation director, office of strategy and innovation, Independence Blue Cross, said the insurer is undertaking a pilot to take data from claims, labs, pharmacies and EHRs to stratify who is at risk of failure to comply at an individual level. Then, each member is individually approached to tailor strategies that work for them.

“We have to engage with individual members to understand who they are and how to reach them. This is part of medication compliance,” he said.