Medication Adherence is a pressing issue in the healthcare setting. New advances in technology using mobile apps and smart devices are now changing the way we approach assessing patients medication adherence. However, this shift also allows a new chance to be engaged with patients regarding their medications and offers the opportunity to be more aware of medication related issues.

1. Timothy Dy Aungst, PharmD

2. Drugs Don’t Work in
Patients Who Don’t
Take Them.
–
C. Everett Koop, M.D.

3. Breaking Down Medication Adherence
Reasons for NonAdherence
Self Discontinuation of Medication – Dose Adjustments –
Cognitive Decline – Concerns on SE/ADRs – Fear of
Addition – Cost – Trust b/n Patient and Provider –
Regimen Complexity – Psychological Status – Over-
Utilization of Medications – Health Literacy –
PolyPharmacy – Unclear Instructions – Multiple
Providers – Medication Reconciliation – Med Errors –
Social Stigma – Failure To Communicate – Many More.
Traditional Means of Assessing Adherence
Categorizing NonAdherence
1
2
3
4
5
Socio/Economic
Health System
Condition Related
Therapy Related
Patient Related
Pill Counts – Surveys – Blood Tests – Measurement of
Physiologic Markers – Blood Markers – Pill Counts –
Medication Refills – Clinical Response – Patient Diaries
Osterberg & Blashke (2005)

4. New Forms of Medication Adherence Interventions
Smart Pill Bottles
Mobile Apps
Ingestible Pill Sensors
Multi-Dose Delivery
The pill bottle has been
upgraded to alert patients
when to take their
medications and let
providers know when the
medications have been
utilized.
Leveraging the smartphone for
medication reminders has never
been easier due to the fact most
users rarely leave home without
it. Same may not be said about
the patients drugs though.
The MDD system is a
relatively old process in
pharmacy, but is making a
comeback as a specially
packaged patient kit
through the use of mail-
order and the Internet.
A new comer to the market, the
ingestible pill comes complete
with a biosensor that alerts users
and providers when a medication
is taken and reaches the
gastrointestinal tract.

5. Mobile Apps – Leveraging the Smartphone
How many Apps?!
Since the rise of the smartphone, there has been a deluge in the number
of medical and healthcare related apps on the market…
App Features:
- Pill Reminders/Alarms
- Scheduled Pill Intake
- Pharmacy Sync
- Data Log
- Patient Diary
- Record SE/ADR
- Cloud Data Sync
- Refill Reminders
Over
20,000
Medical
Apps!
However, a study by Dayer and
Colleagues (2013) identified only 160
apps of interest related to medication
adherence. Still, that is a lot.
The authors created a criteria for
identifying key features to look for in
an app for medication adherence,
and identified only a small number of
apps that would be beneficial.
The issue with Mobile Apps
Apps are appealing for patients as they allow the
user to personally set up their schedule. However,
depending on design this can be a cumbersome
endeavor. Apps are also a poor form of patient
adherence measurement as it is an indirect tool,
and will not benefit most providers or
researchers
Pros:
Cons:
- Cheap
- Easily Accessible
- Cross Platform
Support
- Integration with
Personal Pharmacy
- Multiple Drug Related
References Included
- Indirect Measurement
- Security Issue
- User Dependent
- Many Apps Available

6. Smart Pill Bottles – Rethinking the Amber Vial
Example Companies:
AdhereTech – GlowCaps - Pharm
Assistant – RxAdvance – Kickstarter
So What’s So Different?
10 mg
Cheaper technology, widespread internet connection and integration of
Bluetooth has led to the ability to essentially make any device integrated
and ‘Smarter.’ This isn’t your grandparents pill bottle.
How Does it Work?
The overall idea is that the pill bottle is equipped
with sensors that detect when a medication is
removed (the cap or a weight sensor), and then
sends a message to the app or associated
person of interest that the medication has been
removed. The assumption I that the patient took
it then.
Pros:
Cons:
- Familiar to Patient
- Integration with
Mobile
- Patient Feedback
- Possible Integration
with Pharmacy
- Alerts Providers &
Researchers
- Setup Complication
- Cost
- Needs Wireless
- Indirect Measurement
Beyond the Pill Bottle
Companies and Start-ups are exploring creating
smart pill boxes and pill trays rather than just the
pill bottle. These Smart Stations have other
features such call call features and message
screens that expand standard capabilities.

7. Ingestible Pill Sensors – Now That’s Advanced
Science Meets Medication Tracking
Now this new piece of technology is leveraging the advances made in
biosensors. Essentially, as the sensor is ingested, it breaks down in the
gastrointestinal tract and sends an alert.
Example Companies:
Proteus Digital Health - eTect Bio
Pros:
Cons:
- Direct Measurement of
Medication Intake
- Integration with Mobile
- Patient Feedback
- Possible Integration with
Pharmacy
- Alerts Providers &
Researchers
- Costly
- Logistical Preparation
- Needs Wireless
- Low Widespread Adoption
The Setup
The patient wears an external sensor
attached to the abdomen, that will
pick up the alert from the pill
breakdown. This is then transferred to
an app or provider to alert those
involved that the patient has taken
their medication. Data includes time of
intake and possibly what medication.
Two Different Mechanics
Currently, a patient must either take a
separate sensor, or a capsule that
includes the medication inside.

8. Multi-Dose Delivery - Old Tools in a Digital Age
Example Companies:
PillPack – Integrated Health Information
Systems (IHIS) - Parata – Phillips
Medido – Xubex – Independent
Pharmacies
Pros:
Cons:
- Mail-Order
- Patient Friendly
Utilization
- Good for chronic
disease management
- Logistical Setup
- No Immediate Changes
- Indirect Measurement
Sometimes Simplicity is Easiest
Multi-Dose Delivery Systems are an old tool to package
and dispense medications for patients via strip
packaging. Their home has customarily been in Health
Systems or Long-Term Care, but they are seeing a
resurgence as a possible simplified mechanism to deliver
medications to patients.
Why Now?
A convergence between patients increased use in the
mobile market, acceptance of mail-order and online
delivery methods (thank you Amazon), refinement of
Pharmacy automaton, E-Prescribing, and integration of
online customer support have allowed the ability for
pharmacies to package and deliver MDD services to
patients over a wide area.

9. Which Intervention Should Patients Use?
Smart Pill Bottles
Mobile Apps
Ingestible Pill Sensors
Multi-Dose Delivery
Good For: Patients looking
for an upgraded bottle that
can sync with mobile
devices and beep at them.
Pill stations offer more
services which patient may
desire.
Bad For: Patients who do
not want another piece of
technology clogging up
their medicine cabinet.
Good For: Patients looking for a
concise medication reminder
platform.
Bad For: Patients that need help
with medication organization or
direct clinical support.
Good For: Patients on a
stable medication regimen
looking for a way to easy
way to schedule their meds
through the day and like
mail-order.
Bad For: Patients with
rapidly changing disease
states.
Good For: Patients involved with
clinical studies, want immediate
feedback on ingestion of
medications.
Bad For: Patients who don’t like
wearing sensors.

10. Which Intervention is Beneficial for Research?
Indirect Assessment
Direct Assessment
Pros: Potentially easily to integrate
into current medical research as
similar to current pill bottles used in
clinical trials. Pill bottles may also be
programmed to remind patient to
take their medications for feedback.
Pros: Depending on sensor, can
directly measure patient ingestion of
medication. No reliance on specific
medication organization, and may
better identify true patient regimen.
Cons: Can not directly verify patient
did indeed ingest the medication.
Set-up and need for patient
connection through wireless services.
Cons: Patients required to wear
external sensor in order to function.
Depending on sensor, may require
larger overhead of preparation of
individual medication. Again, reliance
on patient access to services.

11. My Ideal Combination
MDD supplies patient with clear
and concise regimen reviewed
by providers
Ingestible Sensor inserted into Strip
Packaging to provide alerts of medication
Intake
Patient supplied with easily accessible
means of taking medications and can
give feed back to providers
Provider receives alerts on
patient medication intake and
can identify any issues
App platform for
patients and providers
to communicate
through and for patient
to identify any new
problems w/ therapy

12. Upcoming Disruptive Developments
Wearable Integration
Undoubtedly, we will see a
number medication reminders
on smartphones migrate to
wearable devices to provide
similar services. Other potential
results would include
integration with other smart
adherent tools identified as
well.
Gamification Mechanics
Motivating patients to be
adherent to their medications
is an area of interest, especially
it if it can increase consumer
demand and branding. This
includes financial incentives or
membership offers for
participation in the brands
programs.
Drug Device Integration
New sensors are coming to
the market that are meant to
partner with medical devices
(e.g. Inhalers, EpiPens) and
improve functions and make
them ‘Smarter’
Financial Rewards
Store Points
Discounts

13. Technology Alone Won’t Solve Adherence
Technology is Only One
Component to Increasing
Medication Adherence
If patient’s were only forgetting
to take their medications, we
would have solved the issue of
adherence long ago. As
mentioned earlier, taking
medications can be a
complicated endeavor for
patients, and quite frankly is a
difficult issue to tackle. Using
technology may be beneficial
for some patients, and needs
to be addressed on a case-by-
case basis. It is unlikely that
any of the prior mentioned
tools will address all a patients
wants or needs, and that each
intervention may only be
beneficial for select patients.
Engagement and
Communication with
Patients is Key
The beauty of all of this new
technology coming to market
is that it can really push the
paradigm of patient
engagement regarding
medication use. No longer
restrained to office visits,
mobile technology has
offered the ability to
communicate with patients
outside of the clinic and in the
community setting, where
they belong. If technology can
help keep them there, and
can help bridge the gap
between patient and
providers and also empower
patients, then it should be an
option.
Expect More
Disruption to Come
Your Way
Medication Adherence is a
huge area of interest for
multiple parties. Yes patient
care is number one and
improving quality of life. But
lets be frank, its also a
money making area
depending on how you
approach it. So expect new
developments from the
tech industry, start-ups, and
innovators looking to make
it big in the realm of
healthcare. Because if
nothing else, someone
needs to take their drugs
and someone wants to help
them do it.