It’s hard to keep to a medication régime. Most of us (75% according to one survey) fail to keep to them exactly, and many don’t stick to them even approximately. The health and financial costs of non-compliance are huge: for the latter, €100bn in the US annually according to the same source. [Update: For a moving example of the human costs, see Kathy's comment below.] One good reason for keeping us expensively in hospital is that it’s often the only way of ensuring that we do take our pills.
Can anything be done about this?
I’ve been stewing an idea that pharmacies should issue a standardised one-page reminder calendar with every prescription.
Here’s a very rough first draft:
That’s a pretty low-technology approach. It is being overtaken by Progress. There are now lots of smartphone apps that will remind you when to take a pill.
From a very cursory search, I found eight, and there are surely many more. In alphabetical order and with no recommendation:
Dosecast, Medica, Medcoach, MediMemory, OnTimeRx, Pillbox, Pillboxer, PillPaL, RememberItNow!, The Pill Phone.
There is a problem with all of them. The kind of patients willing to enter a complicated medication régime into an app are precisely those least in need of its reminders. We need something reliably usable by forgetful, non-geeky seniors. This means the data has to be entered not the users but by medical professionals: typically by pharmacists and nurses.
There are many possible ways of getting the data into the apps. Web pages and text messages would be simple, but there are security issues. A more secure route would be to print the schedule out in the pharmacy as an Aztec code and read it in – supervised – using the smartphone’s camera. The smartphone RFID readers I enthused about for museum data don’t seem to have taken off.
The precondition for any scheme is standardisation of the data interchange format. One of the aims of health IT programmes is to make prescriptions quicker and less error-prone. The common prescription format presumably includes dosage. Extending this to communication with smartphone apps looks feasible and worthwhile.
Trying to choose among these three: I am a geeky senior; my life is so routine that nothing gets between me and my pills; I should seek a prescription for my OCD problem
Depot medicines are another plausible answer. There are also smart caps to pill jars that have a blinking red light that illuminates if you missed a pill, and a chip that contacts the doctors office wirelessly if you have missed so many that you might be at serious health risk.
Automated text (or, for those w/o text capability, phone) messages might also be a solution. People could sign up for it when they pick up their meds; might be a good selling point for CVS or Walgreens.
These are alternative routes to getting the information to your phone (minus app). You still face the problem of standardisation – the prescription data has to go into the pharmacist’s system. But E-prescribing is coming.
Pill sorters are the easiest, especially for the elderly. They’re low-tech, easy to understand, and give feedback about missed doses. My pharmacy gives them out for free. My only complaint is that pill sorters may not accommodate some unusual pill schedule. Making it easier to stack them and to label them would make them much better.
Joe’s assessment is correct. Pill organizers work great. And, I think they are pretty easy to use. But my local pharmacies do not give them out free. Instead, they sell them at very hefty prices which would keep anyone watching their pennies from buying one (Yes, I’m talking about you, CVS, Walgreens, etc.). They should be free with prescription.
but, the standardized list idea is excellent as well. While it is an excellent idea to keep a complete list of medications take with the schedule for each pill this is too much to expect from many of the elderly and the very ill. No reason the pharmacy computer can’t do this.
I dealt with this very issue for about five years with my (now 87-year old) mother…First there I made a weekly printed checklist & put it on the fridge, which over time she began to forget to look at/check off…then I began to set up a pill organizer for her every week, and would talk with her by phone to ask if she had taken her pills. I thought that was working well, til I discovered that she didn’t often know what day it was.
And then the wheels fell off the whole thing when I discovered she had taken the dog’s pills for two days in a row…Her rheumatologist & the vet both assured me that no harm had likely been done to either, but after that, I made a habit of stopping by before work to set out her pills for the day (and to give the dog his pills) and then I stopped by on the way home from work to be sure the pills had been taken.
In the last 2 years, her dementia has worsened, and she has had a stroke, so I now live with her and am completely responsible for giving her meds. And I sometimes get busy or distracted, and she probably misses getting her pills at the right time once or twice a month…
For people with dementia, developmental delay, mental illness or other cognitive problems, who do not have someone to monitor and help with medications, I think can be very difficult to find a system that works effectively–and takes a lot of trial and error.
Thanks, Kathy, for reminding us that this is far more than a nice technical problem: it can become a significant part of the enormous burden of caring for someone we love and suffer with. Please accept the sympathy and admiration of someone who has recently been spared that particular burden.