Enhancing Medication Adherence Through Technology-Assisted Therapy Drug Monitoring

1. Introduction
Now there are so many emerging technologies that can help therapy, and one of them is a mobile app. A mobile app has very broad access and is suitable for use in reminder and monitoring systems. It can be an alternative to the reminder systems that have been tried using short message service. This mobile app can provide added value in a reminder system because it can have a direct connection to monitoring. Furthermore, this app might facilitate more patients with a variety of features, for example, a simple reminder with a calendar display, education using video, and a chat with medical personnel.
Enhancing adherence to medication can be done in many ways. The previous meta-analysis showed that adherence could improve significantly using reminding systems. The reminder systems themselves can be tailored to the patient’s problem, for example, reminders for patients who are forgetful or education for patients who do not take the meds due to their beliefs. Although reminding systems have proved to be effective at improving adherence, there was not one patient who did not go back to non-adherence. Patients stop taking their meds because they feel no benefit or the meds cause adverse effects. To detect this, a monitoring system is needed. The monitoring can detect whether a patient is still taking their meds and what the outcome of the meds is. This information can be used as feedback to the patient because the patient is still not aware that what they are feeling now is the result of discontinuation of meds. Detection of the outcome of meds is used as a consideration for doctors whether to adjust or change the therapy that has been done. Taking it a step further, the result of monitoring can also be used as evidence for research on the meds. Although so promising, there was not one study that reported using monitoring systems for meds. This drug monitoring can be a bridge to the continuation of the use of reminding systems.
Adherence to medication is so essential that without it, it can cause serious health problems, even death. There are so many clinical studies that have observed the problem of low adherence to medication and have tried to explain it. One of the studies showed that non-adherence to meds reaches 4% – 23% in developed countries, 2% – 59% in developing countries, and 1% – 50% in developed countries. Another study reviewed adherence to meds in long-term therapy in more detail and concluded that most of the patients stopped taking their meds when the meds showed no benefit for them or when the meds caused adverse effects. Low adherence to medication happens not only in developing countries but also in developed countries with different kinds of health problems and meds. This leads to the necessity of finding any method to improve adherence to medication.
1.1. Background
Improved adherence to medication could save many lives and reduce health care costs. Reasons given for poor adherence are varied. They include patient beliefs about their illness and medication (e.g. what it is, its cause, expected duration and perceived severity), characteristics of the treatment regimen (e.g. complexity, duration and side effects) and also importantly, characteristics of the patient. This is a substantial task for the healthcare professional to identify and try to change in order to improve adherence. High rates of poor adherence led to recommendations to assess patient adherence on each visit. However, patients have been shown to overestimate their adherence and many physicians do not accurately assess their patient’s adherence [4]. A study of orthopaedic outpatients found a 40% discrepancy between physician and patient reports of recommended treatment regimens [5]. A more accurate and convenient method of monitoring patient adherence is needed.
The World Health Organisation recognises that improving adherence to medication is crucial to improving health outcomes. Patients with chronic conditions often do not adhere to their medication regimens. A review of 569 studies examining adherence to long-term medication regimens found that on average 24% of doses were not taken; adherence was 75%; and half of the patients stopped their medication within a year [2]. Poor adherence is a major cause of increased morbidity and mortality as well as a reduced quality of life. A study of 96,000 hypertensive patients found that a 20% decrease in adherence was associated with a 14% increase in the risk of death or MI [3]. It is estimated that increasing adherence to medication regimens would have a greater impact on the health of the population than any improvement in specific medical treatments.
1.2. Purpose
The purpose of this essay is to examine the effect of enhanced therapy and drug monitoring on medication adherence. It will also discuss the use of technology in aiding medication adherence. The focus is on the improvements in adherence resulting from the use of a combined intervention of a modified directly observed therapy (MDOT) monitoring system in conjunction with home-based video in asthmatic children and their caregivers. This intervention has not been discussed in prior studies and the early evidence of its efficacy is encouraging. Asthma is chosen as the model disease because of its prevalence, high rate of hospitalization, and necessity for preventative therapy. With the high usage of inhaled corticosteroids and their known side effects, adherence must make adherence a primary concern in the care of pediatric asthma. This essay will use this ongoing study as a reference in the relationship between adherence and clinical outcome. The evidence from other studies on the effects of adherence on clinical outcome will be cited to show the importance of adherence in the care of chronic illness. Technology has been widely used to monitor adherence, and this essay will examine its effect in comparison to traditional methods of adherence monitoring. This essay will also explore possible future advances in medical adherence and how they may affect clinical outcomes in chronic illness.
1.3. Scope
The scope of this essay is to determine if medication adherence among adults 18-64 years of age with a diagnosis of schizophrenia can be increased through the use of technology-assisted therapy drug monitoring and to identify barriers to use of the technology. Medications to treat chronic conditions have often proven to be effective; however, only if taken as prescribed. Among individuals with schizophrenia, nonadherence to antipsychotic medications can range from 40-89% and tends to be highest during the first few months after initial prescription. Nonadherence with antipsychotic regimens can result in a higher risk of relapse, rehospitalization, and suicide-related events and is also associated with higher total costs of care. Types of adherence measurement in the research included: pill count, self-report, clinician rating, monitoring of appointments, and biochemical measures. The most often used approach to measure medication adherence is a patient self report which tends to overestimate adherence levels. Due to limitations of research designs and cultural differences in validity of adherence measures, it is suggested that multiple measures should be used in adherence research. An interactive Voice Response System was found to be effective in specifically identifying nonadherent individuals and inquiring about their reasons for nonadherence. However, this method does not assess actual medication taking, relies on a landline telephone, and is no longer commonly used. Currently the most effective way to monitor medication adherence is using electronic methods. Assessment of electronic monitoring adherence interventions found a significant but small effect in improving adherence when compared to control groups (OR=1.50, 95% CI 1.19-1.90). Due to the findings of this meta-analysis, our research question, was there a change in adherence to antipsychotic medications among adults with schizophrenia after the use of technology-assisted therapy drug monitoring, is relevant in the determination of more effective methods for improving medication adherence.
2. Importance of Medication Adherence
2.1. Impact on Patient Outcomes
2.2. Economic Implications
2.3. Challenges in Medication Adherence
3. Technology-Assisted Therapy
3.1. Definition and Overview
3.2. Types of Technology-Assisted Therapy
3.2.1. Mobile Applications
3.2.2. Smart Pill Dispensers
3.2.3. Electronic Monitoring Devices
4. Drug Monitoring in Medication Adherence
4.1. Role of Drug Monitoring
4.2. Methods of Drug Monitoring
4.2.1. Urine Drug Testing
4.2.2. Blood Testing
4.2.3. Saliva Testing
5. Benefits of Technology-Assisted Drug Monitoring
5.1. Real-Time Data Collection
5.2. Improved Accuracy and Compliance
5.3. Enhanced Patient Engagement
6. Challenges and Limitations
6.1. Privacy and Security Concerns
6.2. Technological Barriers
6.3. Patient Acceptance and Adoption
7. Case Studies
7.1. Case Study 1: Implementation of Mobile Applications
7.2. Case Study 2: Smart Pill Dispenser Pilot Program
7.3. Case Study 3: Electronic Monitoring Device in Clinical Trials
8. Future Directions and Innovations
8.1. Artificial Intelligence in Medication Adherence
8.2. Wearable Technology for Drug Monitoring
8.3. Integration with Electronic Health Records