Digitally tackling side-effects to lever medication adherence: A win-win situation.

Medication Adherence

Have you ever wondered how the term ‘side effect’ came to be used? Well, it has been used since the 1930s1. Surprisingly though, the word came much after the birth of modern pharmaceutical companies in the second half of the 18th century2. In the current age of digital and social media, however, the word side-effect is very commonplace. Isn’t the first thing you do, before you pop the pill, google the side-effects of the medicine your doc just prescribed to you??

And what if you actually experience the side-effects? Will you stop your meds? A lot of people do!

In this blogpost, we will look at how an effective digital patient support program can help tackle side-effects and improve medication adherence.

What are side-effects?

Side-effects are undesirable problems that occur due to a drug. They may be because the treatment effect went beyond the desired level or an additional effect of the drug other than that desired3. For instance therapeutic insulin is supposed to reduce blood sugars in diabetics. But if taken in excess or incorrectly, then it lowers blood sugars a tad too much, causing hypoglycemia. It also causes weight gain when used over prolonged periods of time4.

What are the side-effects of side-effects?

Side-effects are an important cause for poor medication adherence among patients of chronic disease!

Fear of side-effects or poor knowledge about side-effects,  either due to patient or Health care provider related factors cause distress to the patients.

Side-effects are a physical, mental and economic burden to patients and the healthcare system

Story 1: Consider the story of Mrs. Lalitha. She is suffering from a condition called Congestive Heart Failure (CHF). This is a progressive condition that occurs due to the inability of the heart to pump blood to its optimal capacity. Mrs. Lalitha had a heart attack a few years ago and now, at the age of 65 years, she has developed CHF. As the heart cannot effectively pump blood, a lot of fluid is backed up in the abdomen, lungs and legs, causing weight gain, shortness of breath on doing even small physical activities. Mrs. Lalitha was prescribed a medicine to slow the progress of her CHF. On initiating this medication, she developed a cough. The health care provider (HCP) had mentioned to Mrs. Lalitha that this was an expected side-effect and she would need to review if she had this side-effect. Mrs. Lalitha, hence continued the medication, but forgot to review with the HCP. A few days later, Mrs. Lalitha was rushed to the emergency due to extreme difficulty in breathing. What had happened was that her CHF had caused filling up of her lungs with fluid, which was the actual cause of the cough and not the medicine!

Discussion:

Could this have been prevented? And how?

Yes! This could have been prevented! Imagine that Mrs. Lalitha and her daughter-in-law regularly learnt about CHF from the Wellthy CARETM app. They had seen a bite-sized lesson about how to differentiate between cough due to medication and cough due to CHF itself. (Cough due to CHF increases on lying down; while cough due to medication is unaffected by posture. Also, cough due to medication stops as soon as you stop the medicine!) So, they immediately went to the doctor instead of waiting for a couple more days when they realized that the cough increased on lying down.

What lessons do we learn from this unsettling story?

Those patients who are empowered with timely credible information about side-effects and the disease condition can prevent catastrophes. Digital platforms like Wellthy CARETM are instrumental in empowering patients and leading them to the path of optimal self-care.

Story 2: Consider the story of Mrs. Lalitha. She is suffering from a condition called Congestive Heart Failure (CHF). This is a progressive condition that occurs due to the inability of the heart to pump blood to its optimal capacity. Mrs. Lalitha had a heart attack a few years ago and now, at the age of 65 years, she has developed CHF. As the heart cannot effectively pump blood, a lot of fluid is backed up in the abdomen, lungs and legs, causing weight gain, shortness of breath on doing even small physical activities. Mrs. Lalitha was prescribed a medicine to slow the progress of her CHF. On initiating this medication, she developed a cough. The health care provider (HCP) had mentioned to Mrs. Lalitha that this was an expected side-effect and she would need to review if she had this side-effect. Mrs. Lalitha, hence continued the medication, but forgot to review with the HCP. A few days later, Mrs. Lalitha was rushed to the emergency due to extreme difficulty in breathing. What had happened was that her CHF had caused filling up of her lungs with fluid, which was the actual cause of the cough and not the medicine!

Discussion:

Would a wearable device have helped him? It is possible that the wearable device would’ve picked up high heart rate

What about a digital sphygmomanometer linked to his app; would it have picked up her high BP and notified health personnel before the mishap occurred?

How would a holistic digital patient support program (PSP) help the patient achieve medication adherence?

A recent meta-analysis shows that mobile apps that target behaviors of patients, boost medication adherence8. Wellthy CARETM does this with a host of approaches: daily logs, illustrated lessons, quizzes, health coaches and more.

Making a case for Patient Support Programs (PSPs): How can PSPs help patients with side-effects achieve good medication adherence and better health outcomes?

Digital PSPs act as a coach, guide and friend, are non-intimidating and available 24*7. All of Wellthy CARETM’s approaches engage the patient, enabling self-awareness and self-education leading to patient empowerment – a key to better outcomes.

There are multiple points of contact with the patient – digitally, over phone, via the app and through patient generated data, where side-effects and abnormalities can be picked up. Early problem identification leads to early resolution and prevention of adverse events

Conclusion: Not all issues pertaining to chronic disease can be solved in the doctor’s clinic/ office. We need a robust PSP (read: Wellthy!) to deal with the intricacies of chronic disease management; an important aspect of which is addressing side-effects to in turn improve medication adherence.

Reference
  1. side effect | Origin and meaning of phrase side effect by Online Etymology Dictionary [Internet]. [cited 2020 Jul 16]. Available from: https://www.etymonline.com/word/side-effect
  2. A history of the pharmaceutical industry – [Internet]. 2010 [cited 2020 Jul 16]. Available from: https://pharmaphorum.com/articles/a_history_of_the_pharmaceutical_industry/
  3. Definition of Side effects [Internet]. [cited 2020 Jul 24]. Available from: https://www.medicinenet.com/script/main/art.asp?articlekey=5489
  4. Mazzaglia G, Ambrosioni E, Alacqua M, Filippi A, Sessa E, Immordino V, et al. Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients. Circulation. 2009 Oct 20;120(16):1598–605.
  5. Mohiuddin AK. Risks and Reasons Associated with Medication Non-Adherence. 2019;2(2):4.
  6. Mekonnen GB, Gelayee DA. Low Medication Knowledge and Adherence to Oral Chronic Medications among Patients Attending Community Pharmacies: A Cross-Sectional Study in a Low-Income Country [Internet]. Vol. 2020, BioMed Research International. Hindawi; 2020 [cited 2020 Jul 24]. p. e4392058. Available from: https://www.hindawi.com/journals/bmri/2020/4392058/
  7. Longman AJ, Braden CJ, Mishel MH. Side-effects burden, psychological adjustment, and life quality in women with breast cancer: pattern of association over time. Oncol Nurs Forum. 1999 Jun;26(5):909–15.
  8. Armitage LC, Kassavou A, Sutton S. Do mobile device apps designed to support medication adherence demonstrate efficacy? A systematic review of randomised controlled trials, with meta-analysis. BMJ Open. 2020 30;10(1):e032045.