Poor medication adherence is a $300-billion problem that claims an estimated 125,000 lives each year. Numerous technology-based products, such as smart pill bottles, are being marketed to clinicians and consumers alike that promise to improve medication adherence, but there is ongoing debate about their effectiveness. In fact, several large, academic studies suggest that technology solutions have little to no effect on improving medication adherence rates.
The only proven method of ensuring medication adherence is through directly observed therapy (DOT), which was developed by a team of physicians led by Karel Styblo, MD (known as the “father of modern tuberculosis control”), in the 1970s and 1980s to reduce the spread of tuberculosis in Tanzania and other African countries. DOT was later adopted by public health officials to address a resurgence in tuberculosis rates in many major cities.
Emocha (Baltimore, MD), a video-based mobile application that complies with the Health Insurance Portability and Accountability Act (HIPAA), builds on the concept of DOT. Patients record videos of themselves taking their medications, and providers or adherence coaches can communicate with patients if they miss a dose. Through a study funded by the NIH, the emoch platform was associated with adherence rates of 94 percent, which is comparable to in-person DOT.
Although clinicians can review patient recordings to verify adherence without communicating with patients, “it’s more about the engagement back to the patient on a near-daily basis,” explains Sebastian Seiguer, JD, MBA, emocha’s CEO.
For some patients, technology may not be the right solution to address adherence, especially if they find it challenging to pay for medications. Gary LeRoy, MD, a family physician and president-elect of the American Academy of Family Physicians, asks patients to bring in all of their medications in their original containers to help assess adherence. “Just asking, ‘Are you taking the medication?’ is not enough,” he explains. “I want to see what they’re taking and how they’re taking it, or whether the pill bottles look like they have the right amount of medication in them or not.”
Ultimately, LeRoy focuses on gaining patients’ trust so that they feel comfortable bringing their concerns to him. “I want to do my job well, and part of that is working with patients and not just talking at them,” he says. “The greatest technology is establishing a trusting relationship with a patient and making every effort to get them back to full wellness,” he says.
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