Medication adherence: hitting the bull’s eye digitally!

What is medication adherence?

The World Health Organization (WHO) explains that adherence is “the extent to which a person’s behavior – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider”(1). In this article we will focus on adherence to taking medicines (medication adherence). It’s interesting to note that the word ‘agreed recommendations’ appears in the above explanation of adherence. This emphasizes that the patient is an active participant in the process and patient engagement is key to better health outcomes.

Mrs. Damini clearly has poor medication adherence!

Why is good adherence vital for better outcomes?

Improved medication adherence translates to improved health outcomes(2)!

Good adherence decreases long term complications (A large study shows that, in patients with hypertension who are better adherent to medications there was a significantly less risk of developing complications (3))

Better adherence decreases economic burden on health systems and countries(4,5)!

Is our patient- Mrs. Damini’s case of poor medication adherence a common occurrence in India and other countries of the world? And why do patients end up missing their medicines?

Prevalence and factors related to poor adherence:

Mrs. Damini’s story is a common one. Studies show that poor adherence among hypertensive patients ranged from 13% to 54% in India (6,7). Studies in other developed and developing countries show that medication non-adherence varies from 43% to 74% in different chronic diseases(8–10). Reasons for poor adherence vary from poor education by health care providers (HCP) to poor social support for patients(11). High costs of medicines, fear of side-effects, poor knowledge of long-term consequences and presence of comorbidities, resulting in increased pill burden are other factors associated with this problem. As the reasons for poor adherence are multifactorial (patient, physician, disease and health-system related); the measures to improve adherence need to be multi-pronged as well(12)!

Mrs. Damini is not just a statistic contributing to that huge percentage of poor medication adherence. She is a person with real-world problems. How do we help her?

Where does patient engagement fit in?

Consider three scenarios; one, where a patient is not given any advice by the HCP; second, where the patient is advised by a  trained HCP about medication adherence at every follow-up visit roughly three months apart and the third where there is a holistic approach to improve adherence on a day-to-day basis. Intuitively, we know that the third scenario may have better results. Evidence backs this intuition of ours and states that as every patient is unique, it is vital for systems to tailor interventions to the patients’ needs(14). 

The only way this can be done effectively is digitally!

AI-powered interventions can help capture patient generated data, triangulate it with patient behaviours to offer timely and personalized intervention and support. Bringing the patient into focus, enabling them to take informed daily decisions and motivating them to build healthy habits all affect adherence.  This kind of continuous engagement with patients is shown to improve medication adherence.

Mrs. Damini is advised by her general physician to download ‘Wellthy care’ mobile application which is an artificial intelligence backed app that acts as a personal health coach with a wide range of patient engagement options.

Wellthy CareTM and patient engagement: a holistic approach to chronic care

Often, small details are either missed or misinterpreted leading to incorrect practices among patients. For instance, a patient may be taking the pills before instead of after food, resulting in inadequate disease control or unnecessary side effects. Wellthy ensures that such gaps are bridged. Experienced educators are open to queries from patients on a 24*7 basis. 

“Do I need to take so many pills?!” “I missed one dose of medicine today, what do I do?” “I am taking my medicines, yet my blood pressure is high!” The educator would have appropriate answers to all of these, redirect the patient to their physicians as necessary which ultimately  helps the patient improve adherence.

Clinically-validated lessons help patients understand various aspects of self-care, including symptom and side-effect monitoring, guidance on effective best practices, reminders for timely appointments and tests and understanding the long-term implications of non-adherence. Personalized feedback tailored to suit the patient’s needs; interactive lessons, fun challenges and expert coaching are all different ways Wellthy CareTM engages with patients.

The result: a holistic approach and desirable results!

TMapp! It shows in her results too. Her blood pressure is under control and she has managed to lose weight.

Improved medication adherence: Our stakeholders, partners and us at Wellthy Therapeutics

Our patients: Will benefit with better health, lesser complications

Doctors: Can rely on effective digital means (us!) to enhance adherence

Health systems: Decreased burden (fewer admissions, lesser costs!)

Pharma: Pharmacotherapy shows better effectiveness with improved adherence. May harvest digital means to improve adherence in clinical trials as well

Medical devices (Real-time data completes feedback loop to physicians and insurance companies)

 Wellthy Therapeutics thus has the potential to not just hit the bull’s eye and help patients like Mrs. Damini improve her medication adherence, but in turn benefit all stakeholders in this process!

Reference
  1. WHO | ADHERENCE TO LONG-TERM THERAPIES: EVIDENCE FOR ACTION [Internet]. WHO. World Health Organization; [cited 2020 Jul 10]. Available from:
  2. http://www.who.int/chp/knowledge/publications/adherence_report/en/
  3. Marcum ZA, Hanlon JT, Murray MD. Improving Medication Adherence and Health Outcomes in Older Adults: An Evidence-Based Review of Randomized Controlled Trials. Drugs Aging. 2017 Mar;34(3):191–201.
  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. Cutler RL, Fernandez-Llimos F, Frommer M, Benrimoj C, Garcia-Cardenas V. Economic impact of medication non-adherence by disease groups: a systematic review. BMJ Open. 2018 Jan 1;8(1):e016982.
  6. Iuga AO, McGuire MJ. Adherence and health care costs. Risk Manag Healthc Policy. 2014 Feb 20;7:35–44.
  7. Balasubramanian A, Nair SS, Rakesh PS, Leelamoni K. Adherence to treatment among hypertensives of rural Kerala, India. J Fam Med Prim Care. 2018;7(1):64–9.
  8. Mallya SD, Kumar A, Kamath A, Shetty A, T SKR, Mishra S. Assessment of treatment adherence among hypertensive patients in a coastal area of Karnataka, India. Int J Community Med Public Health. 2017 Jan 5;3(8):1998–2003.
  9. Bouwman L, Eeltink CM, Visser O, Janssen JJWM, Maaskant JM. Prevalence and associated factors of medication non-adherence in hematological-oncological patients in their home situation. BMC Cancer. 2017 Nov 9;17(1):739.
  10. Ganasegeran K, Rashid A. The prevalence of medication nonadherence in post-myocardial infarction survivors and its perceived barriers and psychological correlates: a cross-sectional study in a cardiac health facility in Malaysia. Patient Prefer Adherence. 2017 Dec 8;11:1975–85.
  11. Lucca J, Ramesh M, Parthasarathi G, Ram D. Incidence and factors associated with medication nonadherence in patients with mental illness: A cross-sectional study. J Postgrad Med. 2015;61(4):251–6.
  12. Gast A, Mathes T. Medication adherence influencing factors—an (updated) overview of systematic reviews. Syst Rev. 2019 May 10;8(1):112.
  13. Burnier Michel, Egan Brent M. Adherence in Hypertension. Circ Res. 2019 Mar 29;124(7):1124–40.
  14. Jimmy B, Jose J. Patient Medication Adherence: Measures in Daily Practice. Oman Med J. 2011 May;26(3):155–9.
  15. Zullig LL, Bosworth H. Engaging Patients to Optimize Medication Adherence. NEJM Catal [Internet]. 2017 May 14 [cited 2020 Jul 10]; Available from: https://catalyst.nejm.org/doi/abs/10.1056/CAT.17.0489