Pill,The,Adherence,Conundrum,2 marketing Pill, Oh! The Adherence Conundrum

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$2.5 trillion USD is spent annually on healthcare in a developed country like the U.S.A, accounting for a 17.9% gross domestic product and is projected to reach 20% by 2020. Out of this an appalling 30% is wasteful expenditure. Non-adherence causes approximately 30-50% of treatment failures and 125,000 deaths annually. The greatest challenge faced by healthcare providers and administrators is medical non-compliance or non-adherence, which leads to not only an increased burden of medical expenditure but also a reduction in the efficacy and effectiveness of the treatment delivered.  Adherence to treatment means the patient takes the prescribed drugs at the dosage and time decided by the healthcare provider and agreed upon by the patient. Medical persistence is the duration from the time of the initiation till the discontinuation of the therapy. Non-adherence is a vicious circle which leads to poor health outcomes, in turn leading to increased service utilization and increased healthcare costs where again the cost is passed on to the patients.The Antibiotic ApocalypseThe problem of non-adherence does not stop with the high costs incurred by the patient and the government; it has a greater impact on disease control- frequently leading to conditions like antibiotic resistance. In the recent years, there has been an emergence of a lot of cases of diseases such as Multi drug resistant Tuberculosis (MDR-TB) and Totally drug resistant Tuberculosis (TDR-TB). Non-adherence to antibiotic therapies lead to antibiotic resistance as the exposure of the bacteria to suboptimal doses of the antibiotics leads to a milieu where the causative bacteria gain resistance to the antibiotics. This is a feared phenomenon as there are now fewer antibiotics being discovered. Texiobactin, was the first new antibiotic discovered this year after a gap of 30 years. The best way of tackling the resistance problem is making the patient adhere to the prescribed therapy. There are also studies that indicate that the rise of hospitalization in patients with cardiovascular diseases, respiratory diseases and life style disorders such as Diabetes and hypertension is because of non-adherence or non-compliance to medication.How can I make you take your pill?The DOTS (Directly observed Treatments, Short course) was one of the earliest campaigns started by WHO to control the spread of tuberculosis and administer therapy. One of the most fundamental steps in this campaign was to ensure medical adherence, that is ensure that the patient completes the entire course of treatment which not only ensures the patient's cure but also prevents the spread of the disease and phenomena like drug resistance.The recent advancements in healthcare IT has revolutionized medical adherence. Medi Safe is a start up that believes that healthy habits are a key to a healthy lifestyle, especially medical adherence. This company offers an application that tracks your medication and alerts you when you fail to take. It also alerts another person to make sure you do. AdhereTech sells a wireless pill bottle that analyses the patient's usage and to see if they missed dosages and alerts them through their smart phones. It also has the potential to help improve the medical research and clinical trials, hence making sure medicines enter the market faster. These applications not only ensure medical adherence but also minimize the confusion and human errors in patients who take a cocktail of prescription drugs. Accidents due to wrong dosages are fairly common in old patients and patients suffering from chronic illnesses who take more than one drug. A recent study showed that about 32 million Americans-that is 10% of the population are on at least 5 different prescription drugs every day. Half of them don't take them properly adding to the health costs.PillPack is another start up based in Manchester. The company sends medicines by mail order like most other pharmacies. The difference being that the pills are sorted together and packed in plastic pouches that have the date and time you have to take, printed on them. The patient pays the same amount for the medicines but gets an organized prepackaged dosage. This is a big boon for the elderly and also for patients who have to be taking a cocktail of drugs. It is proven that pills packed into doses improve the medical adherence from 61% to 97%. The chief executive of Pillpack, T.J. Parker, says "People are so used to having to deal with the trips to pharmacy, sorting the pill boxes, nagging the pharmacies for refills. People who have been doing this for any amount of time are thankful that we exist".The DownsideEven these convenient facilities and applications come have a flipside. There are potential risks attached to these online pharmacies and applications. The patient's privacy is compromised when the hackers gain access to the patient's medical records. Recently, one such pharmacy was in the news as it had a very unsecure verification process that required only the patient's name and date of birth to gain access to the medical records. It did not even use the social security number of the patients for verification putting the patient at a risk of compromised privacy.Second implication is that, one does not want to be constantly reminded that he or she is a patient. The applications tend to do exactly the same and may have an adverse impact on the psyche of the patient.Thirdly, the doctors play a more important role than merely diagnosing the disease and prescribing a medicine. They need to spend time, counsel patients and create a bond that is just as important as medicines in prognosis. This counseling in fact has a greater chance of ensuring medical adherence. These applications may weaken this bond. In fact, the doctors should play a more active role in ensuring medical adherence and compliance rather than dispensing an occasional reprimand when it does not happen.