Taking your medications as prescribed: Smartphones can help

Robert H. Shmerling, MD

Senior Faculty Editor, Harvard Health Publishing

If you’re like most people, you may have trouble remembering to take your medications as prescribed. If that’s true, your doctor may have called you “noncompliant” or, perhaps, “nonadherent.” Whatever you call it, the phenomenon is quite common: up to 75% of people do not take their medications the way their doctors have recommended. And that could contribute to undertreatment, preventable complications, and even premature death. Estimates put the total costs of medication nonadherence as high as $300 billion each year in the United States.

Why is medication nonadherence so common?

I’ve known patients who never filled their prescription or, after filling it, intentionally reduced the dose. Some may do it to make the bottle of pills last longer, so they’ll save money. Others may reduce the dose or frequency to reduce side effects (or the risk of side effects, even if none have occurred). But, it’s my sense that most nonadherence is unintentional — people simply forget. This is particularly true when the condition (such as high blood pressure) causes no symptoms; conversely, it’s easy to remember to take a medication (such as a pain pill) if forgetting means you’re in agony.

What can be done about medication nonadherence?

The problem of medication nonadherence is not new — doctors have recognized it for decades. Efforts to address it have included

  • educational programs that give patients strategies to avoid missing medications
  • providing medications before people leave the hospital, to avoid gaps in use
  • pill boxes labeled with the days of the week that can be filled in advance
  • simplified medication schedules — for example, some medications prescribed twice a day are just as effective in a higher dose taken once each day
  • periodic “check-in” calls from a nurse, health coach, or other health professionals reminding the person to take his or her medications (and also encouraging other steps to maintain health, such as getting regular exercise or eating right)
  • calls from pharmacies (especially mail-order or specialty pharmacies) to individuals or their doctors to remind them about a prescription that should be running out (provided it is being taken properly). While this may be self-serving (because a pharmacy loses money when prescriptions go unfilled), it does tend to encourage adherence.

Can your smartphone help you take medication as instructed?

As smartphones became ubiquitous, it didn’t take long for people to realize they could be used as a reminder system. And that has applied to medication use: setting an alarm or entering information in the calendar are now commonplace and can help reduce nonadherence.

A new study demonstrates a new way smartphones can be helpful for medication adherence: texting. For this study, researchers analyzed 16 previous studies that included more than 2,700 people with chronic diseases and found that text message reminders more than doubled their chances of medication adherence. That’s impressive, but this analysis does have some limitations:

  • The studies tended to include younger patients (half were under age 40).
  • Definitions of adherence varied: for example, some studies defined it as 80% of medications taken as prescribed, while others required up to 95%,
  • The types of messages also varied — some used personalized two-way messaging, while others used automated messages.

Future research should help answer some important questions: Which type of messaging system is best? Do the reminders need to continue indefinitely? Do these reminders actually improve health? Will these reminders work as well in people with a brief illness (such as strep throat) as in the people in these studies, who had chronic illnesses?

But despite the caveats, I’m encouraged by this new report. If a person is committed to taking his or her medications as prescribed, technology can help make it happen.

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