Edited by Adam Da Costa Gomes
In an already-busy world, remembering to take one’s medications can be extremely difficult. For some, a simple dosette or blister pack can help with medication adherence, which is the term used to describe an individual's ability to correctly take or administer their medications. For others, like my grandfather, a blister pack may not be enough to lead to a patient’s improved adherence. Over the last year in particular, I’ve watched my grandfather struggle to remember to take his pills and the negative physical and mental health impacts that it has had on him. This is what sparked my interest into how medication adherence can be improved within our communities. It is a known fact that half of all patients do not use their medications as prescribed. With the evolving healthcare system, ways to improve medication adherence should continue to evolve too.
Dosettes and Blister Packs
In the USA, about 50% of filled prescriptions are taken incorrectly. This can mean that the medication was taken at the wrong dose, at the wrong time, or for the wrong duration. Sometimes, these medication adherence problems can be solved with blister packs or dosettes, like our namesake. These are packages of medications organized into small compartments for each day. In some cases, they have multiple compartments for different times of the day. An example of a dosette can be seen below.
In one study, it was found that the use of blister packs for patients over the age of 65 increased medication adherence by 35%. These organization solutions can be reusable and refillable like the option seen below, or they can be disposable, one-time use packages. One drawback of blister packs that should be noted is that it can only be used for tablet or capsule medications. Medications that come in other formats, such as creams or ointments, cannot be put into blister packs or dosettes. Many pharmacies offer blister pack services for their patients, usually at no additional cost. Be sure to talk to your local pharmacist if you are interested in and/or think that you could benefit from a blister pack.
Medication Reminder Apps
In 2018, there were over 97,000 mobile health apps available to be used on smart devices, including apps to help patients remember to take their medications. There are many different free and paid apps that can help patients remember which medications to take at what time. Most apps have a reminder function where there is either an alarm, notification, or text message that alerts when a medication is meant to be taken or administered. Two apps that were rated highly by patients include Dosecast and Medisafe. While apps may be a great solution for some, there are drawbacks that exist. As mentioned previously, some of these apps are associated with a cost which may be a barrier for some individuals. Secondly, it is important to note that medication adherence issues are most commonly seen in elderly individuals. It is also known that elderly individuals are usually less familiar or connected with technology and are more likely to have issues with dexterity or hand-eye coordination. Therefore, the group that could benefit the most from the use of apps may also have the most barriers to using the apps.
Would you swallow a digital pill? In the 21st century, different digital pills have been developed for patient use. It was only 10 years ago that the first technology sensor was approved by the Food and Drug Administration (FDA). The ID-Capsule, which was approved in late-2019, is a good example to explain how a digital pill can help with medication adherence. Each ID-Capsule has an ingestible sensor that produces a radio signal once it comes into contact with stomach fluid. Any drug that is able to be swallowed orally can be placed within the ID-Capsule. The patient wears a reader device which will use Bluetooth technology to forward the information given by the sensor to an app that can be viewed by the patient. This app will show information about what medications have been taken as well as transmit data to a server for doctors or healthcare professionals to view. A benefit of the digital pill is that both patients and medical professionals can monitor how well medication instructions are being adhered to. However, similar to blister packs and dosettes, this technology will not help in adherence for medications not taken by mouth and swallowed, such as inhalers, creams, or sprays.
There are many ways to help improve medication adherence including dosettes, apps, and digital pills. However, it is important to note that the ability to remember taking medications is not the only thing that can cause issues with medication adherence. Many other factors can get in the way of taking medications properly, such as cost, an inability to use the medication (e.g., unable to push down on the canister of an inhaler to release the medication) or an inability to physically open the medication containers. If you ever find yourself unable to take your medications as prescribed for any reason, it is important to talk to your pharmacist or another trusted medical professional to implement the appropriate strategies. Remember, not taking medications as prescribed, also known as poor medication adherence, is one of the most significant barriers in having the best possible results from using medications.
Baumgartner SL, Buffkin J, Rukavina E, Jones J, Weiler E, Carnes TC. A Novel Digital Pill System for Medication Adherence Measurement and Reporting: Usability Validation Study. JMIR human factors. 2021;8(4):e30786-e30786. doi:10.2196/30786
Neiman AB, Ruppar T, Ho M, et al. CDC Grand Rounds: Improving Medication Adherence for Chronic Disease Management — Innovations and Opportunities. MMWR Morb Mortal Wkly Rep 2017;66. http://dx.doi.org/10.15585/mmwr.mm6645a2
Jeannie K. Lee, P., Karen A. Grace, P., & Allen J. Taylor, M. (2006, December 6). Effect of a Pharmacy Care Program on Medication Adherence and Persistence, Blood Pressure, and Low-Density Lipoprotein Cholesterol. doi:10.1001/jama.296.21.joc60162
Ahmed I, Ahmad NS, Ali S, et al. Medication Adherence Apps: Review and Content Analysis. JMIR mHealth and uHealth. 2018;6(3):e62-e62. doi:10.2196/mhealth.6432
Backes C, Moyano C, Rimaud C, Bienvenu C, Schneider MP. Digital medication adherence support: Could healthcare providers recommend Mobile Health Apps? Frontiers in Medical Technology. 2021;2. doi:10.3389/fmedt.2020.616242
Voelker R. Digital Pill Gains Approval. JAMA : the journal of the American Medical Association. 2018;319(1):14-14. doi:10.1001/jama.2017.19309
Chan A, Vervloet M, Lycett H, Brabers A, van Dijk L, Horne R. Development and validation of a self-report measure of practical barriers to medication adherence: the Medication Practical barriers to Adherence Questionnaire (MPRAQ). British journal of clinical pharmacology. 2021;87(11):4197-4211. doi:10.1111/bcp.14744