Digital Innovations to Enhance Medication Adherence: Internet-Based Strategies and Solutions

Pharmacotherapy is a double-edged sword: it can save or prolong lives and alleviate the suffering caused by disease, but irrational use of medications can lead to new illnesses or even death. In recent years, medication-related problems—such as poor patient adherence, medication errors, drug interactions, adverse drug reactions, overmedication, and underdosing—have become major barriers to the safe, effective, and economical use of medicines by the public. Survey data indicate that one year after initiating treatment, fewer than 50% of patients remain strictly adherent to their prescribed regimens.

Low medication adherence directly results in losses in two areas. First, it leads to the loss of medical costs and resources. According to statistics from the IMS Institute for Healthcare Informatics, in the United States, expenditures on avoidable hospitalizations, outpatient treatments, and prescriptions caused by poor medication adherence account for 8% of the total national healthcare spending. On average, for every $1 Americans spend on medications to treat diseases, an additional $1.77 is spent on managing medication-related problems.

Second, it exacerbates patients' health problems and may even lead to death. According to surveys, poor adherence results in approximately 125,000 deaths annually, accounting for 10% of all hospitalizations and 23% of nursing home admissions.

In light of this, many medical researchers seek to identify the root causes of the problem. It has been found that the reasons for non-adherence to pharmacotherapy are multifaceted, involving physician-related, pharmacist-related, and patient-related factors, as well as numerous sociological, economic, medical, and behavioral determinants. Specifically, these can be categorized into nine main types, among which poor social support is a primary factor affecting adherence.

In response, many pharmaceutical companies and technology firms have also turned their attention to medication-related issues, hoping to thoroughly eradicate this long-standing societal problem through digital means such as apps, gamification, electronic health records (EHR), patient platforms, smart pill bottles, and digital pills.

Mobile Healthcare

Mobile phones have become an effective tool for improving patient adherence due to their ubiquity and convenience. According to VCBeat, there are numerous mobile applications abroad designed for medication tracking, whereas China currently lacks standalone apps specifically targeted at enhancing patient adherence. App-based tools primarily function by providing medication reminders and tracking therapeutic outcomes. For example:

• MediSafe

MediSafe is a cloud-synced medication reminder app that helps patients, their families, and caregivers easily manage complex medication regimens in real time. The application enables users to receive timely medical guidance and identify potential personal factors contributing to their conditions. MediSafe also supports quick addition of medications by scanning barcodes via the device’s camera. Its user-friendly interface features a circular layout that allows users to see at a glance which medications are due and at what times throughout the day. The team reports that Medication adherence among users has risen to 86% with MediSafe reminders, significantly higher than the 50% rate observed in typical patients. In 2014, MediSafe won the Grand Prize at the 4th annual QPrize International Seed-Stage Funding Competition hosted by Qualcomm Ventures.

• CardioSmart Med Reminder, a medication tracking app that allows patients to track their medications, set custom alerts, and share their medication lists with doctors and pharmacists.

Lindsey Dayer, Pharm.D., an assistant professor at the College of Pharmacy, University of Arkansas for Medical Sciences in Little Rock, Arkansas, led a team that ranked 160 medication adherence apps based on attributes such as online data entry, searchable drug databases, and the ability to transmit medication regimens via reminder devices. After a comprehensive evaluation, MyMedSchedule, RxmindMe, and MyMeds emerged as the top three, distinguished by their outstanding basic medication reminder functions and other enhanced features.

A simpler approach is SMS reminders, which also appear to be highly effective; a study on the use of SMS reminders among patients with hypertension showed that adherence increased to 43%.

Gamification

Patients who take their medication on time are rewarded through “incentives” and “prizes.” Users can earn points by adhering to their treatment plans, completing quizzes, and updating their prescription information; these points can then be redeemed for shopping gift cards, discounts, and other rewards.

• Mango Health

A company combating medication non-adherence through gamification. By motivating users daily and alerting them to potentially harmful situations, it enhances their physical safety. In addition to checking for drug interactions, the application allows users to create detailed activity logs, develop and maintain schedules, make reasonable comparisons with others taking the same medications or having similar conditions, and earn incentive points that can be redeemed for product discounts, tangible rewards, and corresponding medical advice.

Compared to standard alarm reminders, it addresses the tedious issue of forgetting to take medication by employing gamification and tangible incentives. Furthermore, it shifts users from a passive to an active role: if users fail to promptly open the app via Mango’s notifications and mark “I took it,” Mango will not wait indefinitely; instead, it will directly strike through the entry in the user’s history to indicate a missed dose, without providing any alternative means for remediation. It also provides essential medication-related information, such as dietary advice, drug details (including brand and precautions), and potential drug-drug interactions, tailored to the specific medication. It has established a partnership with Target.

• HealthPrize

Medication non-adherence is primarily addressed through four approaches: education, gamification, reminders, and rewards. Last October, partnerships were established sequentially with two companies: West Pharmaceutical Services, a manufacturer of injection drug delivery devices, and the pharmaceutical company Connexions Loyalty. Among these initiatives, HealthPrize and West Pharmaceutical Services co-developed a customized device that enables patients’ smartphones to detect when medication has been injected. This information is recorded on the HealthPrize platform, and patients who administer their injections on schedule receive rewards.

• Ayogo Health

It is another company leveraging the power of mobile gaming to enhance medication adherence. Their game, Monster Manor, helps children with type 1 diabetes adhere to testing and logging routines. By harnessing the engaging nature of social networks and the powerful motivational drivers of gaming and entertainment, it assists patients in establishing new healthy habits tailored to their specific medical conditions.

Ayogo has formed significant partnerships with several influential organizations worldwide, such as the Joslin Diabetes Center (Harvard Medical School), Sanofi-Aventis, the Center for Computational Medicine at the University of Southern California (Keck School of Medicine), and the Diabetes Foundation.

Electronic Health Record (EHR)

The Centers for Medicare & Medicaid Services (CMS) established the EHR Medicare Incentive Program and defined “Meaningful Use,” while the Office of the National Coordinator for Health Information Technology (ONC) issued standards and certification criteria to guide EHR system standards, promote patient medication adherence, and provide patients with access to their medical data (e.g., medication lists, prescriptions) and electronic prescribing.

A further description of “meaningful use” is that medication adherence can be improved through the following measures:

• Electronically generate and transmit authorized prescriptions;




• Exchange of critical clinical information among providers;




• Grant patients access to their medical data;




• Enable automatic clinical decision support;




• Implement drug formulary checks;

Patient Web Platform

In China, examples include Tangyou Network, Sweet Home, and Kan Chufang. The main functions of the current web platforms are:
Provide the current medication list and related information on specialty medications;
Drug information from suppliers can be shared;
Request prescriptions from physicians, schedule doctor appointments, and communicate with the care team;
Access to laboratory results and the right for vendors to share diagnoses;

Smart Pill Bottle

Smart pill bottles are no longer just silent containers sitting on a shelf. They can send reminders, track usage, change color, emit sounds, and more.

• AdhereTech

An intelligent pill bottle with built-in sensors has been invented. It reminds patients to take their medication on time by continuously monitoring the remaining quantity of medicine in the bottle. When it is time to take the medication, the bottle turns blue; if the patient fails to take the medication as scheduled, the bottle turns red and alerts the patient to adhere to the dosing schedule.

• PharmAssistant

A smart pill bottle with Bluetooth connectivity has been launched. Through a companion mobile app, this small pill bottle can remind you when it’s time to take your medication and help you track your adherence. First, the pill bottle does not require purchasing additional data plans from carriers; it simply connects to your smartphone via Bluetooth. Furthermore, PharmAssistant can connect to a drug database to provide alerts and warnings about drug interactions. In other words, if you link all your medications to the app, it can determine which drugs should not be taken simultaneously.

• GlowCap

GlowCap requires the installation of a connectivity hub in the home; to receive reminder services, the medication bottle must communicate with this hub. While traveling, GlowCap can store data but cannot provide services. In contrast, PharmAssistant relies on smartphones, thereby avoiding such limitations.

Vitality launched a smart pill bottle with light and sound reminders in 2009. The bottle can remotely monitor your medication adherence via AT&T’s wireless network and send the information to doctors. After several shifts in business focus, it sold GlowCaps to patients through Amazon.com and CVS.com, and was later acquired by NantHealth.

Smart Pills

In addition to smart pill bottles, some companies have also begun to focus on pills.

• Proteus Digital Health

Proteus Digital Health has developed an ingestible biomedical sensor that, when paired with a wearable patch and a smartphone, transmits data on the body’s physiological responses and behaviors. The Proteus platform enables products to capture and analyze physiological and behavioral data, applying these insights to areas such as patient monitoring, health and fitness tools, and clinical trials.

This is not the only company producing “digital pills.” Another company, HQ, offers a similar product called the CorTemp Ingestible Core Body Temperature Sensor. This pill features a built-in battery and can transit through the human body to monitor core body temperature. It is already being used by firefighters, football players, soldiers, and astronauts to prevent overheating in high-temperature environments.

Software Analysis

It is also aimed at addressing the issue of ensuring patients take their medications on time, but through a different approach—big data.

• RxAnte

RxAnte’s technology leverages millions of patient medical records and personal data to identify individuals at highest risk of non-adherence, including those with a history of poor compliance, patients on polypharmacy regimens, and those exhibiting aversion to medication side effects. This enables the prediction of patient behavioral patterns and the implementation of targeted interventions.

• AllazoHealth

Although they do not directly serve patients but rather health insurance companies and pharmacy benefit managers (PBMs) in the United States (third-party administrators of various prescription drug programs), they ultimately serve the patients associated with these institutions. They leverage demographic, behavioral, and other data related to individual patients to identify which patients are adherent to their medication regimens and which are not. Then, for each specific patient, the system determines the optimal intervention strategy to encourage medication adherence—such as real-time phone calls, automated messages, or emails. AllazoHealth claims that its prediction accuracy regarding patient medication adherence is as high as 97%.