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Innovative solutions to increase adherence in healthcare

Vikram Srivastava
Thursday, November 22, 2012, 08:00 Hrs  [IST]

The reason for non-adherence in healthcare is largely due to multiple factors , both intentional and non-intentional. The  reasons can range from factors such as forgetfulness, affordability, alternate therapy, lack of awareness, drug availability etc. This causes major losses for pharma companies  to the extend of approx. US$ 300 billion as per the report by Capgemini (9th Edition Global Research Report).

Similarly for patients it leads to loss in terms of developing complications which might lead to hospitalization which further leads to increase in cost.  Issue of non-adherence has been discussed at various forums and events highlighting the challenges and how to combat the same.  The criticality of non-adherence is higher when it comes to chronic disease.

Adherence not only covers the medication / treatment part but also includes periodic check-up and regular doctor visit as advised.  Disease management companies along with the pharmaceutical companies and HCP can play a significant role in increasing adherence by identifying the key areas as per the socio-economic and cultural background and introducing innovative solution in order to reach out to the different chronic diseases patients.  Involvement of caretaker and encouragement of self-management should be the key objectives.

Innovative measures to increase adherence
While devising any innovative measures for increasing adherence , it should focus on 10 main areas  such as which chronic disease type, demographic i.e. age group & gender, education (read-write capability), technology comfort, social acceptance of the disease, geographical region catered, patient mental status and caregivers role, drug availability, economic status, insurance cover.  All these measures increase the possibility of innovation acceptance and execution..

Mobile technology
It is expected that there will be four  to five  billion cell phone subscribers across the globe by 2012. Health related mobile technology has been developed so that cell phones can be used for drug adherence. For example, patients can send or receive a text when they are scheduled to take a dose of the medicine. Sending a text message each time that the medication is utilized could help patients remember whether or not they took their medication. Additionally, knowing that they must report each medication dosage can help to improve adherence. However, this method also has associated problems. First, there is still no way to know how honest patients are being, since they could be reporting adherence through text message without actually taking their medication. Or, a patient could take the medication, but forget to send the text message.

Additionally, in many areas in the developing world, network availability is limited, and often unreliable. Further, if the phone breaks, patients may be afraid to ask for a new one, and may stop refilling their prescription. It is very important to explore how cell phones can be used to improve drug adherence, but currently there is much that still needs to be done to make it a quality option. As India’s mobile user market is growing at a staggering pace this kind of technology can be adapted to the billion population of India at very economical rates.

Measuring tools
New technological methods of measuring patient adherence are also being developed. The first of these, which some believe to be the best available option, is the wireless pill container. These new pill containers hold a chip in their cap, which sends a signal to an alert system whenever the container is opened. Like many new technologies, it is too expensive to be used widely. Also, although the container's recording would signify a fairly good chance that the patient had taken his or her dose, it does not assure that someone else did not take the pill, or that the pill was taken at all. Nothing to lose heart if this piece of innovation can be adapted with local manufacturing with few modification adherence rate can be taken to the next level especially in Asia and Africa.

Smart pills
There are also new technologies called wireless ingestion monitors. These methods give more accurate information than the wireless pill container, and it also makes use of cell phones. One version, MagneTrace, is a monitor in a necklace, or sometimes in a patch form, which uses magnetic sensors to detect when a pill, which also contains a magnet, goes through the wearer’s oesophagus. The data of when pills have been taken are recorded on a phone carried by the patient, who then sends this information to the health care provider. Of the new methods, MagneTrace gives the most certainty that the patient has indeed taken the pill. However, as with all of these forms of technology, it has its own challenges like high prices, and the necklace could also create a stigma towards those wearing the necklace but certainly in times to come this can be changed and acceptance can go up. Opening new frontiers in innovation to increase adherence by Kartavya

Behavioural solutions
Kartavya Healtheon has been undertaking various innovative measures to address the above issues such as introduction of cancer game develop by Hope Lab Foundation to cater to young cancer patients who understand and can use technology with ease.  The game not just creates awareness about cancer but at the same time motivates them to fight cancer cells which increases adherence.

The objective is to provide learning about the disease in an engaging way thereby increasing adherence and also motivate the patients.

Gamification will teach patients how to recognise and control symptoms and encourage pro-activity among patients and other stakeholders. The hope is that patients   understand their diseases better and leading to greater adherence which could in turn lead to better quality of life. In the long run, better adherence could lead to reduced treatment costs especially in chronic diseases

Unconventional solutions
An effective way to improve patient compliance and adherence is to alert the patient when it is time for them to take their medication. This can be done through audio and visual signals or a combination of both.

Kartavya Healtheon along with Med Time Compliance has introduced compliance card which can be programmed as per the dosage interval of medicines by patients, the device alerts the patient (beeping sound) to have their medication at the programmed time every time.

The Compliance Card delivers medication management solutions designed to help individuals stay healthy, get healthy and live with an illness.  Kartavya Healtheon delivers an integrated, cohesive approach to managing the health of each individual, as an individual.  The Compliance Card can help million’s of people take better control of their health and the health of their family.
The MedTime/Kartavya programmes are designed with these principles in mind — reduce adverse medication events, present better medication outcomes & change behavioural health with ground-breaking technology, coordinating-care solutions that focus on the “total health and productivity” of the consumer.Most importantly, Kartavya  programmes can be clinically integrated across the entire continuum of care, regardless of which medical or speciality health problems our clients work with.

Personalised engagement solutions
Similarly for reminders of medication , Kartavya provides various options of reminders from SMS alerts to IVRS system which reminds the patient to have their medicine at a pre-schedule time.

For those who prefer to speak on phone, toll free numbers enable patients to seek additional information about disease and condition as well as the medicines they are consuming. Kartavya provides regional touch to their patients by servicing them in 10 various Indian languages.

As per the medication due date of the patient he or she is reminded five days prior for continuing on the therapy and importance of adherence.

Kartavya would in time to come bring in path breaking technological advancements for increasing adherence in healthcare.

The author is  Co-Founder and Director, Kartavya Healtheon


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