Wanted: Nudges for helping people take their medicines

In a fascinating piece for Slate, Jessica Wapner highlights a great example of a self-control problem: Failing to take your medicine (In the medical community this is known as patient non-compliance).

Overall, about half of us fail to correctly follow our doctors’ directions for prescriptions. Wapner gives examples of three interesting technological nudges for helping patients take their pills.

1) A necklace developed by Georgia Tech scientists that records the date and time when a patient swallows a pill, and reminds her (and her doctor) when a dose is missed.

2) A prosthetic tooth that releases medicine into a patient’s mouth.

3) A “smart” pill bottle that sends message to a pharmacist about dosages and refills. (A similar “smart” pillbox has also been developed.)

Non-compliance is not a behavior that only affects the patient. It affects the rest of us through unnecessary medical costs and lost revenue that could be as high as $177 billion annually in the U.S. Technological nudges are welcomed, but reducing noncompliance will probably require 1) more research into who the non-compliers are and why the fail to follow their doctors’ orders, and 2) health policy that deals more comprehensively with non-compliance problems.

For example, Congress is considering a bill that would tie Medicare payments to physicians’ use of e-Prescription technology that tends to increase generic use and formulary compliance, thereby decreasing overall costs. Similar policy specifications may be worth considering for products or procedures that increase patient compliance.

There is evidence that the amount of money patients pay for doctors visits and pharmaceuticals affects the frequency with which they take medication properly. Higher doctor visit fees can raise barriers to compliance (patients may not pick up a needed medication or skip a dosage period), meaning co-payment designs are one policy tool for affecting health care behaviors.

David Nash, a medical professor at Jefferson College, suggests that one option for governments and companies is the adoption of benefit-based co-payment designs. These systems have tiered co-payments where levels depend on the seriousness of the illness, where drugs required to treat chronic conditions and drugs that have strong records of effectiveness have lower co-payments. In some cases, this may even mean co-payments of $0.

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5 Responses to “Wanted: Nudges for helping people take their medicines”

  1. Peter Kaplan Says:

    How about making pill-popping part of the national lunchtime culture? Once the media and the flag-waving government and local workplaces project it as “the right thing to do” and provide free, mandatory placebo pills for everyone across America, pill-popping will become part of a personal and national routine, causing individuals to get in the habit of taking pills every lunchtime, whether they happen to be on medication at the moment or not. Habit-forming, as they say. 🙂

  2. Kelly Hubbell Says:

    There is another proven technique to help with adhereance (a term I prefer to compliance). Although it is a little low tech for this discussion.
    Employ someone in the physician’s office to call patients and ask how they are doing on their medicine. A series of questions can be adopted to help the office staff find out what barriers might be occuring and to help the patient problem solve and/or re-negotiate perscription level, etc.

  3. Alex Sicre Says:

    Thanks for linking to my blog for your medication non-adherence stats! Medication Non-adherence is at at all time high, now costing $300B in unnecessary healthcare costs and lost revenue. And it is across all ages, educational and economic demographics, and all disease states – sometimes hitting 64%. Forgetfulness is the #1 reason cited @ 84%.

    The dog collar and fake tooth are intrusive technological advancements, requiring the patient to adapt to the technology. ExHale (I think) has created an interesting way to monitor adherence by adding an ingredient to HIV meds which then shows up on a breathalizer.

    @Kelly Hubbell – interesting idea, however, the average MD sees about 1500 patients, and to call all of them would tie up the already over worked front office staff.

    An unobtrusive method of Nudges, is provided by Intelecare, a healthcare technology company dedicated to increasing patient medical adherence (FD I am the Director of Corporate Development). We offer a free service developed around our proprietary messaging platform that sends patient and caregiver created reminders via email, text and voice messaging.

    Intelecare reminder options include daily medications, prescription refills, doctors’ appointments and vital stat monitoring all delivered how and when the patient /caregiver wants them. Currently, we have over 3.2M active users.

    I hope Intelecare’s service is a good addition to your list of Nudges for medication adherence.


  4. EA Says:

    I was having trouble taking my medication, and my doctor gave me a simple nudge that I still think about – he asked me how many times I missed my medication, then extrapolated that to the percentage of medication I missed over a week and a month. Once I realized that I was missing out on almost 40% of my treatment, I started to rethink taking my medication in terms of percentages of healing. For some reason, it worked.

  5. Mark Harrison Says:

    Text messages to a mobile and or an email timed to nudge the patient when to take the medicine can easily be set up. Trouble is how do you know the medicine has been ‘taken’ and not disposed of? Returning the empty medicine package at the point of a clinical check up or at repeat prescription time may help. Random drug tests for the unwell or else?

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