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Can digital health/mobile health improve medication adherence?

Can digital health/mobile health improve medication adherence? | Salud digital |

For one reason or another, as many as half the patients in the United States don’t take the medication that is prescribed to them at a cost to the US healthcare system of $290 billion a yearin waste. That’s according to NEHI, formerly known as the New England Healthcare Institute, which has been tracking the medication adherence problem for years.

Mobile and digital health’s potential to help bring about healthy behavior changes has led a number of companies to target the problem with new connected devices, applications, and services. Some of these have claimed to be highly effective: MediSafe recently stated that their app raised users’ adherence rate to 81 percent over the course of its first eight weeks that it was made available, and Vitality GlowCaps once reported pushing adherence rates to as high as 98 percent, both well above the World Health Organization average of 50 percent. NEHI has stated that digital health offerings similar to these have considerably improved adherence, but the market penetration for these tools is still low.

The challenge for these companies is not just to develop an effective product, but also to figure out who will pay for it. That means addressing the sticky question of whose problem med adherence really is.

Patients don’t take their medication for a number of reasons. Forgetfulness is one, particularly in chronic disease patients who have a large regimen of pills to keep track of and in elderly patients who may have poor memories or become confused easily. But other patients don’t take their meds for psychological reasons: some patients “feel fine” and skip a drug, some are concerned about real side effects. Some, according to NEHI Senior Health Policy Associate Nick McNeill, are concerned about imagined side effects. Finally, many patients stop taking medications because they simply can’t afford the co-pay. This, of course, is not a complete list but it does include some of the more commonly referenced reasons. Digital health could play a role in resolving some of them.


Apps, caps, and pillboxes

Several startups working in this space originally launched as direct to consumer plays but many have since pivoted (or appear poised to pivot) and now market to providers, insurers, or pharmacies. The relevant digital health products for medication adherence typically fit into one of three categories: apps, smart pillboxes, and smart pill caps. Apps, like Janssen’s Care4Today and the Walgreens app, offer reminders and calendars to help keep track of meds, and even tools for communicating with the pharmacy to refill prescriptions. These are likely to remain patient-facing, and they primarily address the problems of forgetfulness and inconvenience.

Vitality’s GlowCap is a smart pill cap that launched in 2009. Once a user enters a medication dose schedule into an online portal, the pill cap glows and plays a melody when it’s time to take a pill. Vitality started out offering the product directly to consumers via The product, with its attractive display and branding, was marketed as a consumer electronic device. After the company was acquired by Nant Health, it pivoted on that strategy and currently only distributes GlowCaps through partnerships with employers and pharmaceutical companies. However, The Washington Post reported last week that the company plans to make Glowcaps commercially available once more in February through an undisclosed retailer.

MedMinder, a company that makes large, smart pillboxes, also launched in 2009. MedMinder does target consumers, specifically elderly people who take a lot of medications. The pillbox connects via satellite so patients can use it even if they don’t have Internet or even a phone line at home. It has multiple trays for different medications and sends reminders if patients don’t open the trays when they should — first to the patient, and then to a family member.

“We don’t see it only as ‘adherence’, we also see it as helping people stay independent at home,” MedMinder President Eran Shavelsky told MobiHealthNews. “Adherence has several aspects to it that we are trying to solve. Obviously one aspect is that people forget. They need to get nice, friendly reminders that help them take medication on time, and if they don’t then we inform the family. Another problem is overdosing.” Toward that end, MedMinder’s newest product is a locking version of their pillbox, to guard against patients becoming confused and trying to take a pill twice.

MedMinder does sell directly to patients, but with its focus on elderly patients they’re also marketing to the patients’ caregivers and grown-up children. The company also partners with pharmacies and some health insurers.

A newer company, MediSafe Project, also leverages family to improve medication adherence. MediSafe is a cloud-based app solution — the patient gets a reminder to take their meds on their smartphone app, and a prompt to tell the app when they do. If they don’t indicate that they’ve taken their dose, a graduated series of friends and family — the MediSafe Safety Net — is informed.

“It pushes you a notification when its time to take your meds,” said MediSafe CEO Omri “Bob” Shor. “The first one is a quiet one, like a text message. The second one is a louder one. The third one you can’t ignore, and the fourth one goes to your wife.”


MediSafe wants to use big data as an incentive to encourage pharmaceutical companies to partner with them by aggregating anonymous adherence data for various drugs.

At the recent CES 2013 event, two companies showed off their digital health adherence solutions to drum up support for their crowdfunding campaigns on Indiegogo: uBox by Abiogenix and GeckoCap.

GeckoCap is an adherence offering for kids who have asthma. The system consists of a smart inhaler cap and an app that helps parents track their kids’ inhaler use and uses gamified features to encourage kids to keep up with their medication as well.

The uBox, on the other hand, is a general purpose smart pillbox. A locking, spinning carousel, the uBox is also connected to an app that includes schedules, a calendar, and the ability to notify family members about missed doses.

“Adherence is a very complex and very human problem,” said Abiogenix co-founder Sara Cinnamon. “Medication, the way it’s delivered today, is an open system. Maybe the patient fills it at the pharmacy, maybe they don’t. The doctor has no idea, and at a followup if the treatment’s not going well they don’t have any objective information.”

That highlights another feature of several of these solutions — self-tracking. Not only does a mobile app or smart pillbox remind you to take your pills, it gives you a record you can give to your doctor that shows your adherence.

Cinnamon said the company is starting out by marketing directly to consumers, but it plans to partner with pharmacies, possibly so patients can get their pills pre-filled. The company has also run some pilots with the uBox at addiction treatment centers.

“I don’t see them as direct competitors,” she said of the other companies in the space. “We’re all trying to solve the same problem and there are different ways of solving it. We’re trying to focus on younger patients who have a more active lifestyle, who want to be proactive in taking care of themselves.

Via Chatu Jayadewa
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ONC's 'Three A's' Plan to promote engagement through e-Health

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Positive results to medication adherence in renal patient study

Positive results to medication adherence in renal patient study | Salud digital |


Background: Mobile phone based remote monitoring of medication adherence and physiological parameters has the potential of improving long-term graft outcomes in the recipients of kidney transplants. This technology is promising as it is relatively inexpensive, can include intuitive software and may offer the ability to conduct close patient monitoring in a non-intrusive manner. This includes the optimal management of comorbidities such as hypertension and diabetes. There is, however, a lack of data assessing the attitudes of renal transplant recipients toward this technology, especially among ethnic minorities.
Objective: To assess the attitudes of renal transplant recipients toward mobile phone based remote monitoring and management of their medical regimen; and to identify demographic or clinical characteristics that impact on this attitude.
Methods: After a 10 minute demonstration of a prototype mobile phone based monitoring system, a 10 item questionnaire regarding attitude toward remote monitoring and the technology was administered to the participants, along with the 10 item Perceived Stress Scale and the 7 item Morisky Medication Adherence Scale.
Results: Between February and April 2012, a total of 99 renal transplant recipients were identified and agreed to participate in the survey. The results of the survey indicate that while 90% (87/97) of respondents own a mobile phone, only 7% (7/98) had any prior knowledge of mobile phone based remote monitoring. Despite this, the majority of respondents, 79% (78/99), reported a positive attitude toward the use of a prototype system if it came at no cost to themselves. Blacks were more likely than whites to own smartphones (43.1%, 28/65 vs 20.6%, 7/34; P=.03) and held a more positive attitude toward free use of the prototype system than whites (4.25±0.88 vs 3.76±1.07; P=.02).
Conclusions: The data demonstrates that kidney transplant recipients have a positive overall attitude toward mobile phone based health technology (mHealth). Additionally, the data demonstrates that most kidney transplant recipients own and are comfortable using mobile phones and that many of these patients already own and use smart mobile phones. The respondents felt that mHealth offers an opportunity for improved self-efficacy and improved provider driven medical management. Respondents were comfortable with the idea of being monitored using mobile technology and are confident that their privacy can be protected. The small subset of kidney transplant recipients who are less interested in mHealth may be less technologically adept as reflected by their lower mobile phone ownership rates. As a whole, kidney transplant recipients are receptive to the technology and believe in its utility.

(J Med Internet Res 2013;15(1):e6)

Via Chatu Jayadewa
Chatu Jayadewa's curator insight, January 16, 2013 10:29 AM

It's promising to see evidence of remote monitoring leading to increased adherence. Whilst we are seeing an increase in the use of telehealth and mobile health related applications and they are adoption, adherence is still a  major issue in chronic patients. When the monitoring programs require these poorly adherent paitents to wear medical devices and interact with a management systems (via mobile or PC) we are faced with the risk of lack of motivation once again leading to poor adherence to the monitoring system itself!


Adoption strategy therefore is a vital part of telehealth programs and it would be interesting to see the outcome of more long term studies.


Also see WHO report on adherence below. Whilst this is now significantly out of date the basics still remain valid


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¿Se puede calcular el ROI de las TICs en salud?

¿Se puede calcular el ROI de las TICs en salud? | Salud digital |

¿Cómo se calcula el retorno de la inversión (ROI) en tecnología médica (TICs)?¿Se diferencia de la forma en que lo hacen en otras industrias?
Ese fue el tema de una reciente discusión en el sitio de LinkedIn de la Healthcare Information Management and Systems Society (HIMSS). El consenso fue que, aunque el valor se mide algo diferente en sanidad que en otras industrias, es posible medir el ROI de las TICs en salud. Una investigación de esta sociedad determinó que "la definición tradicional de retorno de la inversión tal como se utiliza en otros sectores no es necesariamente una buena opción para la industria de la salud, ya que implica más que sólo mirar cuánto dinero se ahorra o gana".

En el cálculo de ROI, la HIMSS recomienda que los proveedores deben considerar los siguientes factores:
- Ahorros por eficiencia.
- La mejora de los resultados de la atención en comparación la situación previa a la implementación de las TICs.
- Los ingresos adicionales generados como resultado de una implementación de TICs.
- Factores no financieros, tales como mayor satisfacción del paciente con la atención, disminución del tiempo de los proveedores en el trabajo, y mayores niveles de satisfacción de los empleados.
- Mayor conocimiento de los proveedores acerca de la población de pacientes que atienden.

Algunos participantes de la discusión se mostraron escépticos acerca de la afirmación de que la asistencia sanitaria es diferente de otras industrias. Como dijo un participante, "Eso de que la salud es diferente sigue sonando como una excusa para no ser más cautelosos en cómo el dinero está siendo gastado (perdido) y, además, todos los costes reales están siendo registrados".

Otro participante señaló que la vida y la muerte están en juego no sólo en la salud, sino también en otros campos, como la industria aérea. "El cálculo de retorno de la inversión en intangibles es cada poco el reto en otras industrias, como lo es en las TICs con respecto a la asistencia sanitaria", dijo. "Tal vez hay algunas cosas en la asistencia sanitaria que son más difíciles de cuantificar, pero puede y debe hacerse."

También citado en el debate fue el ejemplo de Unity Health Care, un proveedor de red de seguridad en el área de Washington DC. Dijo que en un período de dos años, su aplicación de registro electrónico de salud resultó en $ 12,2 millones de dólares en ingresos adicionales. Ese aumento de los ingresos superaban con creces los $ 5,5 millones que se invirtieron. Y el retorno de la inversión también incluyó $ 2,66 millones en incentivos del gobierno.

COM SALUD's curator insight, January 30, 2013 4:45 AM

Unos baremos estandarizados de ahorro y de mejora de la asistencia sanitaria ayudarían a las administraciones a implementar las TICs en salud. Es difícil convencer a los gestores sanitarios de la necesidad de invertir, sobre todo en esta época, sin datos de ROI. Por eso, proveedores, profesionales, centros y autoridades deben colaborar en la elaboración de esos baremos. Hace unos años la tarea era casi imposible, pero los programas actuales de manejo de big data, lo han puesto al alcance de la mano.