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No Single Intervention Can Cure Poor Medication Adherence

Jessie GrumanYou are sick with something-or-other and your doctor writes you a prescription for a medication.  She briefly tells you what it’s for and how to take it.  You go to the pharmacy, pick up the medication, go home and follow the instructions, right?  I mean, how hard could it be?

Pretty hard, it appears.  Between 20 percent to 80 percent of us – differing by disease and drug – don’t seem to be able to do it.

There are, of course, many reasons we aren’t.  Drugs are sometimes too pricey, so we don’t fill the prescription. Or we buy them and then apply our ingenuity to making them last longer by splitting pills and otherwise experimenting with the dosage.

Some drugs have to be taken at specific times or under specific conditions, posing little challenge when you are taking only one.  But it can be devilishly difficult to coordinate the green pill half an hour before breakfast, the yellow ones on an empty stomach four times a day and the orange one with a snack between meals.  It’s complicated; we don’t understand.  We’re busy; we forget. We’re sick; it’s confusing.

Some drugs produce uncomfortable side effects while others set off an allergic reaction. Every single day, we have to decide if the promised outcomes are worth the discomfort.

Kate Lorig, the developer of the Chronic Disease Self-Management Program, has listened to thousands of people talk about the challenges they face in taking their medications as prescribed.  “One of the reasons that folks do not take their meds is that they think they are not doing anything,” Lorig says. “This is especially true of medications that replace something that you no longer produce like thyroxin or medications for chronic conditions that help you get worse more slowly.   The trajectory of a disease is not something one can usually sense, and people start feeling that their drugs are not making them better. Another problem is that people expect drugs to work at once like aspirin and antibiotics.   Many drugs take days, weeks or even months for people to feel better.  They lose patience.” Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

No Forgetting To Take Your Meds

Normally, the patient calls the pharmacy for a prescription. Now, the prescription is doing that by itself. GlowCaps, a prescription bottle cap made by Vitality, has assumed control for medication compliance.

The bottle cap fits prescription bottles, but has uses cellphone technology to tap into wireless networks. Once connected, the pill bottle does everything imaginable to remind patients to take their pills.

There’s lights — plenty of them. The bottle cap really does glow and make noise to remind patients. Plug-in units wirelessly connected to the bottle cap can be placed anywhere there’s a wall socket. Oh, and it will call you, too, if you forget. The company calls this “Reminders Ramp from Subtle to Insistent.” (Add “relentless” to that.)

Ultimately, GlowCaps tallies compliance and sends reports to caregivers and physicians. Not surprisingly, studies show that constant nagging to take one’s medications works.

*This blog post was originally published at ACP Internist*

Conversations At An HIV Clinic: Medication Costs And Side Effects

“I like your watch,” pharmacist Jin Jun tells me as I’m sitting down to interview him.

I have a plastic runner’s watch, nothing special, but I see Jun is wearing something similar. “Do you run?” I ask him.

Jun is a tall, personable man who runs marathons, it turns out, and he enthusiastically invites me to run in a 5K race this weekend. I’m not sure I’ll be able to make it but I ask him for the details anyway.

Jun is equally passionate about his job, which one day a week involves helping the patients at the Carolinas Medical Center Infectious Disease Clinic with HIV drug adherence. I ask him how he handles cases like LaShana Walker’s, where some days she just doesn’t feel like taking her medications because they make her so nauseous. Read more »

*This blog post was originally published at The Daily Monthly*

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