It is clear that patient compliance with prescribed medications is critical to success in the treatment of any chronic disease process. In addition, patient engagement and co-management of their disease has been proven to improve outcomes. This past month, a new study from the Annals of Internal Medicine suggests that any changes in the appearance of a medication may result in a decrease in compliance – when a pill looks different, patients often simply stop taking it as prescribed. In this study, a change in pill color was associated with a 34 percent increase in medication discontinuation, and a change in pill shape was associated with a 66 percent increase in medication discontinuation. In cardiovascular patients in particular, the sudden discontinuation of medications can result in increased hospitalizations for chest pain, congestive heart failure and other more serious acute cardiovascular events. For other disease processes, such as diabetes, medication non-compliance can be devastating and life threatening as well.
The Challenges of Managing Poly-Pharmacy
In general, today's patients are taking more medications for a multitude of ailments, and even for the most astute patients, keeping track of doses and regimens can be a challenge. Add in changes in color and appearance of chronic medications and the task can often be overwhelming, especially for elderly patients with cognitive decline. According to a study published in the Journal of the American Medical Association in 2008, nearly 81 percent of adults aged 57-85 took at least one pill, and 29 percent took five or more drugs. In addition, nearly 50 percent took concomitant over-the-counter drugs and/or supplements as well. Side effects, drug-on-drug interactions, and other concerns have led many physicians to attempt to streamline medication use and avoid the dreaded "poly-pharmacy" patient. However, this serious public health problem is further complicated by patient non-compliance issues. Many regulators argue for more FDA intervention as well as requiring generic drug makers to conform to non-generic shapes and colors when manufacturing generic substitutes. However, I believe that this data argues for a more comprehensive, patient-centered approach to increasing medication compliance.
Leveraging Technology in Seniors
Technology today is ubiquitous in nearly all age groups. According to a Pew Research poll, most seniors utilize the internet and a large majority of these users interact via tablets, computer or other mobile devices. As we age, we tend to live with more chronic illnesses and seem to require more daily medications. Given the fact that seniors are now actively engaged on the internet, it makes sense for medical professionals to use these powerful tools to assist patients with the management of their disease. Many EMR systems already incorporate "patient portals," which allow for direct patient access to certain parts of their medical record such as test results, appointments, etc. In addition, there are websites such as Pill Identifier that allow patients and physicians to search a large database of drug images in order to more accurately identify a medication – this is particularly useful when a patient approaches a visit in an emergency room or has a consultation with a new physician.
Based on the newly released study in Annals, it is clear that pill identification (and consistency of appearance) is critical in maintaining patient compliance with chronic medical regimens. Regulatory agencies are slow to act – forcing private generic drug makers to keep the size, shape and color of the generic consistent with the brand name is not realistic. I believe that we can use tablet technology to quickly address this issue. What if we create an application (downloadable to mobile phone, tablet and laptop) that is able to quickly identify all shapes, colors and sizes of a particular drug? Currently there is a pill identifier app on the market, but it requires the user to enter color, shape and size in order to identify the correct medication – are there better apps yet to come? Ease of use and accuracy will be key components to any new medical applications aimed at older adults.
What Are Potential Solutions? What Can We Do Now?
As health care providers, we must do a better job encouraging the use of technology to help identify drugs and promote compliance. The Annals study is a stark reminder that even though we may prescribe the best, most evidence-based regimen to treat disease, it takes very little for our patients to become sidetracked – something as simple as a change in shape or color may result in the discontinuation of an effective, potentially life-saving medical treatment. As physicians, we sometimes forget the "simple things," such as the importance of consistency and routine for our patients. The culture of health care in the U.S. no longer allows for the extended office visit and frequent follow up in order to ensure that patients are compliant with their treatment plans – we are asked to see more patients in less time and the documentation requirements have become paramount in practice. We must look for alternative ways to assist our patients with managing their disease while at home – I believe technology is the answer. We must provide education and resources for our patients and assist them in the identification and use of medical applications. With technology, we may be able to extend our reach – and support for our patients – well beyond the walls of our office.
This post originally appeared on Dr. Campbell's self-titled blog on August 10, 2014.