{"id":6993,"date":"2021-01-26T09:59:34","date_gmt":"2021-01-26T14:59:34","guid":{"rendered":"https:\/\/desis.osu.edu\/seniorthesis\/?p=6993"},"modified":"2021-01-26T09:59:36","modified_gmt":"2021-01-26T14:59:36","slug":"people-dont-take-their-pills-only-one-thing-seems-to-help","status":"publish","type":"post","link":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/2021\/01\/26\/people-dont-take-their-pills-only-one-thing-seems-to-help\/","title":{"rendered":"People Don\u2019t Take Their Pills. Only One Thing Seems to Help."},"content":{"rendered":"\n

For all that Americans spend on prescription drugs \u2014 $425 billion last year<\/a> \u2014 you\u2019d think we\u2019d actually take our medicine.<\/p>\n\n\n\n

But one of the frustrating truths about American health care is that half or more of prescribed medication is never taken.<\/p>\n\n\n\n

It\u2019s called medication nonadherence, and it\u2019s a\u00a0well documented\u00a0and\u00a0longstanding\u00a0problem, particularly for patients with chronic conditions. The drugs they\u2019re prescribed are intended to\u00a0prevent costly complications, reduce hospitalization, even keep them alive<\/a>. But even when the stakes are high, many patients don\u2019t take their meds.<\/p>\n\n\n\n

This seems like a problem we ought to be able to solve. It motivates high tech approaches,\u00a0like digital pills<\/a>\u00a0that can automatically communicate to doctors that they\u2019ve been taken.<\/p>\n\n\n\n

Maybe people forget to take their meds \u2014 about 60 percent<\/a> of people say as much \u2014 so we just need to remind them. Maybe people don\u2019t understand the value of what they\u2019re prescribed, so we just need to educate them. Maybe drug regimens are too complex, so we just need to simplify dosing.<\/p>\n\n\n\n

All these methods have been tried. It\u2019s not so clear any of them work very well.<\/p>\n\n\n\n

Only one approach has\u00a0repeatedly been shown<\/a>\u00a0to be effective:\u00a0reducing the cost<\/a>\u00a0of medications.<\/p>\n\n\n\n

First, let\u2019s look at the research on the other methods. So-called reminder packaging \u2014 pill packaging or containers that organize drugs by single dose or day of the week \u2014 is a relatively simple idea intended to help people remember to take their prescribed dose.<\/p>\n\n\n\n

A systematic review<\/a>\u00a0by the Cochrane Collaboration found that it was helpful in doing so, but only modestly. Surveying 12 randomized controlled trials, the authors concluded that reminder packaging increased the number of pills taken by patients by 11 percentage points. But they also found that most of the studies had significant methodological flaws, casting doubt on the findings.\u00a0Other systematic reviews<\/a>\u00a0of reminder packaging studies also found\u00a0problems with the research<\/a>, like small sample sizes and short follow-up periods.<\/p>\n\n\n\n

Perhaps reminder packaging is too passive, and patients need something like an alarm to alert them when they\u2019ve missed a dose. Electronic pill monitors can do that. Some just remind patients to take their medication. More sophisticated ones alert doctors when they don\u2019t. In 2014, a team of researchers from the Brigham and Women\u2019s Hospital and Harvard Medical School published a systematic review<\/a> of such devices in the Journal of the American Medical Association. Here, too, the results are disappointing. Most studies of such devices do not detect improvement in adherence.<\/p>\n\n\n\n

A recent randomized trial<\/a> not included in these systematic reviews tested three dose reminder approaches for people with a chronic health condition or depression: a pill bottle with toggles for each day of the week<\/a> that can be changed after each daily dose; a pill bottle cap with a digital timer<\/a> displaying the time elapsed since the medication was last taken; and a pill organizer with a compartment for every day of the week<\/a>. Over 50,000 subjects were assigned randomly to one of these approaches or to none, as a control.<\/p>\n\n\n\n

None of the devices performed better than the control in getting patients to take their medications. One possible explanation is that forgetfulness may not be why<\/a> patients don\u2019t take their medications as prescribed. Drug costs, a wish to avoid side effects, and a desire to be less reliant on drugs are some of the other reasons patients don\u2019t take them.<\/p>\n\n\n\n

\u201cIt is also possible that for reminder devices to be effective, they need to be coupled with other adherence-improvement strategies,\u201d said Niteesh Choudhry, lead author of the study and a physician with Brigham and Women\u2019s Hospital and Harvard Medical School.<\/p>\n\n\n\n

That\u2019s why augmenting electronic monitoring with other information or assistance delivered to patients may be more successful, if more expensive. For example, one study<\/a> found that the adherence of hypertensive patients increased when digital display containers were combined with a blood pressure cuff and a card for recording blood pressure. This suggests that when patients receive feedback that signals how well they are controlling their condition, they may be more willing to take their medication.<\/p>\n\n\n\n

Still, it isn\u2019t hard to find studies that show that even with considerable support, getting patients to take medications can be challenging. A Cochrane review<\/a> examined randomized controlled trials of interventions \u2014 across many dimensions \u2014 to increase medication adherence. Reminder packaging and alarms were just some of the methods assessed, with approaches including patient and family education about the value of medication, and mail or telephone follow-up.<\/p>\n\n\n\n

Of the 182 randomized trials reviewed, four stood out as the most methodologically sound. Among those, two increased adherence but two did not. Over all, the authors concluded that there was a lack of convincing evidence that even complex and costly interventions significantly increased patients\u2019 compliance with drug regimens.<\/p>\n\n\n\n

\u201cA cure for nonadherence is nowhere to be seen,\u201d they wrote. A more recent study<\/a> not included in the Cochrane review found that not even providing patients with financial incentives and social support<\/a>, along with pill bottles that signal when a dose should be taken, was enough to boost adherence among heart attack survivors.<\/p>\n\n\n\n

So why is price so important?<\/p>\n\n\n\n

When drugs cost them less, patients are more likely to fill prescriptions. Even if people have already purchased drugs, they may skip doses \u2014 or split the pills \u2014 because of concerns that they won\u2019t be able to afford future refills. Free drugs don\u2019t get everyone to take them<\/a>, but many more do so than if they have to pay for them.<\/p>\n\n\n\n

For those with certain chronic conditions<\/a>, extra help in affording medications can reduce adverse events and hospitalizations<\/a> \u2014 a big increase in quality of life, as well as a potential benefit to the wider health care system and the economy.<\/p>\n\n\n\n

Lowering prescription drug costs has been a longstanding pursuit for many politicians, and Medicare Part D and the Affordable Care Act helped (although most Americans\u00a0still say<\/a>\u00a0costs are too high). President Trump said drug companies \u201chave been getting away with murder,\u201d but lower drug costs have not yet been a top priority of this White House.<\/p>\n\n\n\n

\n\n\n\n

This article analyzes the past approaches people have taken to increase medical adherence. However, they conclude that cost of medication is one of the biggest factors that when reduced, has the best success in increasing adherence. This is also related to health insurance literacy because when people are aware of medications that are covered by their insurance, they are more likely to adhere to taking them. It is a policy concern to address the high cost of medications and the health insurance issue in our country. However, in the scope of design and this course, using the idea of a lack of health insurance literacy is a great starting point towards developing a concept that effectively addresses pharmaceutical literacy. <\/p>\n","protected":false},"excerpt":{"rendered":"

For all that Americans spend on prescription drugs \u2014 $425 billion last year \u2014 you\u2019d think we\u2019d actually take our medicine. But one of the frustrating truths about American health care is that half or more of prescribed medication is never taken. It\u2019s called medication nonadherence, and it\u2019s a\u00a0well documented\u00a0and\u00a0longstanding\u00a0problem, particularly for patients with chronic conditions. […]<\/p>\n","protected":false},"author":41,"featured_media":6995,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[26],"tags":[],"class_list":{"0":"post-6993","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-focus"},"_links":{"self":[{"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/posts\/6993","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/users\/41"}],"replies":[{"embeddable":true,"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/comments?post=6993"}],"version-history":[{"count":1,"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/posts\/6993\/revisions"}],"predecessor-version":[{"id":7000,"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/posts\/6993\/revisions\/7000"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/media\/6995"}],"wp:attachment":[{"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/media?parent=6993"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/categories?post=6993"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/desis.osu.edu\/seniorthesis\/index.php\/wp-json\/wp\/v2\/tags?post=6993"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}