By Dr. Batami Sadan, Co-Founder and Board Member, Vaica Medical , chair of the Israeli Association for Medical Informatics
The New England Journal of Medicine recently published an article titled, “Swallowing a Spy — the Potential Uses of Digital Adherence Monitoring“. It caught my attention and led me to wonder: are there effective ways to improve a patient’s adherence to medication while still respecting their independence and privacy? We all know that medications don’t work if you don’t take them. And, we can all agree that non-adherence can often lead to potentially severe clinical consequences as well as high costs to the patient, their families, not to mention the entire health system. Considering, this is a serious issue that needs to be addressed.
Take patients with schizophrenia as an example. Estimated non-adherence rates in this patient population are about 50%. These findings, coupled with the fact that non-adherence is indeed preventable, makes finding a solution for this phenomenon especially important for those in psychiatry. So, what are the current choices?
Well, as cited in the article noted above, the U.S. Food and Drug Administration recently approved the first drug in the U.S. with a digital ingestion tracking system. Abilify MyCite (aripiprazole tablets) has an embedded, ingestible sensor that records when the tablet is taken. The product is FDA approved for the treatment of various mental health disorders including schizophrenia.
Abilify MyCite works by sending a message from the pill’s sensor to a wearable patch. The patch transmits the information to a mobile application so that patients can track the ingestion of the medication on their smart phone. Patients can also permit their caregivers and physician to access the information through a web-based portal.
Though this seems to be a full proof system, it is very invasive and could discourage patients from even trying to adhere, thus worsening the problem. As the article’s author concludes: “If the loss of our healthier selves is a bitter pill to swallow, that pill is no sweeter when embedded with a sensor”. I totally agree. In my opinion, such exaggerated monitoring, which is beyond our control, is a sinner to the trend of patient autonomy, empowerment and shared decision making of the patient and physician.
That said, I do not believe, however, that the story ends here. I believe that there are more proven interventions that can indeed enhance a patient’s adherence while respecting their beliefs and autonomy. In order for patients to believe in the positive effects of a suggested treatment, physicians must include their patients in the decision-making process by tailoring relevant information to patient’s level of understanding. Studies have shown that patients who understand the purpose of the prescription are likely to adhere twice as much. The good news is there are indeed alternatives to the pill sensor solution, which are not only less invasive but also quite efficient in improving adherence by among other deliverables, giving patients a sense of independence and control. I will continue to explore the options in a future blog.