As No One Person, Brand or Theory Has Cracked the Adherence Code, now Technology Takes Its Turn

By September 27, 2009Uncategorized

Pill cpunter

Novartis Developing Chip to Remind Patients to Take Pills
Patients who often forget to take regular doses of medicines will now be reminded by a "chip on their shoulder". Switzerland's Novartis and technology company, Proteus Biomedical have joined hands to develop the innovative idea, reports Britain's Telegraph newspaper. The sensor would also help doctors keep a check on their patients' medication regime. (

I was fortunate that last Fall co-led a two-day conference last fall called, "The Barriers to Patient Non-Adherence." Thirty-seven patient advocacy group representing over 50 conditions, all came together under the umbrella and good grace of this major pharma company to try and debunk the myths and come to some core beliefs across groups about what action to take.

Technology never came up. Oh sure, everyone talked about email and Internet, but I do not consider that technology. Everyone focused on behavior, money and communication. One thought leader we invited spoke to Value-Based Insurance Design as one solution; another went the route of behavior modification.

This week's news that Novartis was developing a technology reminder that was cleverly called, "chip on your shoulder" was fascinating in many ways, and perhaps inevitable. E-CRM programs are hard to measure and only a portion of patients and caregivers will join. Direct mail is old world and effective, but only the economic efficiencies of on-demand digital printing has made it possible for so many brands to create their own 'magazine."

But technology. Could this be the answer? Let's look at the wide range of devices that are in the market to help patients stay adherent. Just go to a big pharmacy and walk down some aisles, or this stuff is usually nearer to the counter. Lots of watch reminders — set the time, it beeps, you take pill. Pill cutters. The 7-day brightly colored pill box, each days' letter on top of each sequestered chamber. Then there is the pill bottle coming with the chip sensor in the top, to record wireless-ly the number of times it was opened. Debit and co-pay cards that track usage bt tracking transactions. Ttelephone reminder messages. 


Pill counter cap

Is it me, or is something missing?

If you want to really think about non-adherence, you need to first start out, as demeaning as this sounds, thinking of the patient as a ill behaved teenager. Why? Because nothing you do seems to make a big difference. It's like no matter what you say or do – consequences, hope, fear, bribes, on and on, none do the trick. They might move the dime 5% one direction, but that is it. Why are we just such knowingly mis-behaving creatures?

Behaviorists, like Prochaska, and my friend who worked with him, Dr Cynthia Willey, an epidemiologist out of University of Rhode Island, would sum the problem up in book-ending the patient behavior: if the patient does not "accept" the diagnosis and the need for treatment, then they will not be compliant. Equallyy, if they DO accept, and stick with the medication regimen for 6 months and make it a part of everyday habits, then they will succeed.

My own research at Ryan TrueHealth has shown that people also have a myriad of human and historical barriers nothing can overcome. Influences like, how their family perceived health and medicine growing-up, or Influencers like the lack of a pharmacist attention or the negative reactions of family members.

So, as we look at what is currently in the market, no one has ever implemented the right mix of behavior models, human touch, use of online and offline media, and co-opting the Influencers to build a holistic approach. (MS may be closest.)

Now, why if we have not gotten even proven that the right mix of these insights and devices — from call center, to live chat, to co-pay cards and emails — why would we believe that a wireless chip will crack this code?

The real solution, like so many things, is a human-based one. And that means that if people will not comply, if they will knowingly act against their own self-interest, in this case their health, it does mean that all is hopeless. It just means we cannot be seduced by the hubris of portable wireless technology as the missing piece.

I like the chip idea. I think its cool. It will be even better if it attaches to the emerging EHR technologies. But there are so many other barriers we need to address first, and use technology as a platform for a "human" solution — one that offers a range of means to convince the patient early, and support them at key intervals through multiple channels — this is the answer we should focus on.

And you know what seems to be the most effective tool used to date? That darned weekly pill holder. Ugly, bad product design, yellow or some tacky color, cheap and intrusive. For those of us with elderly parents, it works.

I do not have the answer, but I see the ingredients. And it begins and ends with human insights, all else is a tool. The final caveat: has anyone really thought about who and how many will actually wear this chip? Hmm. Maybe calling "chip on your shoulder" may not be the best name.