Ring, Buzz, Flash: It Must Be Time to Take Your Medicine
Wall Street Journal Link: http://on.wsj.com/WqnPeM
People accustomed to nagging from doctors and family members that they’re not taking their medications properly may get some help from an unlikely source. New designs for drug packages and plans for labels that are easier to understand aim to help people stick to their drug regimens.
New technologies include a bottle cap with a wireless chip that signals to patients if they are late in taking their medicine by triggering flashing lights and audible alerts.
Recent research has found that packaging pills in blister packs, rather than typical amber-colored vials, may be more likely to get patients to take their pills. Blister packs, in which each pill is enclosed in its own compartment marked with the day of the week, help remind people if they’re up-to-date with their medications.
Meanwhile, the jumble of consumer information that accompanies medications—which may include a bottle label, an information sheet stapled to the bag, a package insert from the drug manufacturer and another insert sometimes required by the U.S. Food and Drug Administration—makes it harder for patients to follow instructions.
“The redundancy ultimately causes more confusion and may result in patients altogether avoiding all the material they receive,” says Michael Wolf, associate professor of medicine at Northwestern University’s Feinberg School of Medicine.
An FDA spokeswoman said the agency is working to consolidate all the information that consumers receive with prescription medicines into one document.
Patients who don’t take their medications as directed increase their health risk, especially in the case of chronic conditions such as diabetes and hypertension. A 2010 report from the New England Healthcare Institute, a research organization, found that one-third to one-half of U.S. patients on medication for chronic illnesses don’t adhere to their drug regimen.
Health insurers also have a stake in improving patients’ drug-adherence rates. Under the Affordable Care Act, which is scheduled to take full effect in 2014, reimbursements to health-care plans that get government funding, such as Medicare Advantage, will be based in part on how well members refill prescriptions in three classifications of drugs: cholesterol, hypertension and diabetes.
Blister packs with calendar markings for pills are already used for certain medications in some pharmacies, including Wal-Mart and Kroger . Wal-Mart says it plans to expand the use of the packages for more types of drugs this year.
Drug maker Novartis Pharmaceuticals Corp. set out to learn just how effective blister packs, sometimes called reminder packaging, are at getting patients to take their medications. In a study published in 2012 in the journal Patient Preference and Adherence, researchers from Novartis and Xcenda, a consulting firm, examined pharmacy claims from more than 9,000 patients taking hypertension drug Diovan HCT. About half the patients filled their prescriptions at Wal-Mart and got the drug in a calendar blister pack called a Shellpak, made by packaging company MeadWestvaco Corp. The other patients received the pills in bottles from other pharmacies.
Over the course of a year, patients using the blister packs refilled their prescriptions five days sooner on average than those using bottles and stayed on their medication 22 days longer, the study found. A Novartis spokeswoman says the company introduced a 30-count blister pack for Diovan HCT in July, after piloting the product with Wal-Mart beginning in 2009. Novartis is considering using this type of packaging with other products, she says.
Hayden Bosworth, a professor of medicine at Duke University, says more research needs to be done. Studies, such as the Novartis analysis, are observational rather than randomized controlled trials, he says. And evidence needs to be gathered that the additional cost of using blister packs is worth any potential gain in drug-regimen adherence, he says. Dr. Bosworth says he is currently working with MeadWestvaco to conduct a randomized controlled clinical trial that assesses the benefits of blister packs. The company estimates that blister packs cost as much as three times the price of a traditional pill bottle.
Some companies are developing technology to improve drug-adherence rates. GlowCap, made by Vitality Inc., fits on most prescription bottles. The cap contains a wireless chip that communicates with a light plug—akin to a night light—which pulses orange when you’ve forgotten to take a pill. The cap also flashes and chirps. If the bottle still isn’t opened after a scheduled dose time, patients get a series of escalating reminders.
Mike Trevino, general manager of Vitality, which is a unit of NantHealth of Los Angeles, says GlowCaps are currently sold to pharmaceutical manufacturers and self-insured employers. He says the caps are scheduled to go on sale in February through a large retailer, which he declined to name, and will become available for purchase online for $79.99 plus a monthly service fee.
Other innovations include placing a QR code on a pill-bottle label that consumers can scan with a smartphone to download a short video with information about the drug. The codes are produced by VUCAHealth, an Orlando, Fla.-based health-care-technology company, which says it plans to roll out the product in coming weeks to various clients.
Rx Timer Cap LLC, in Thousand Oaks, Calif., sells pill-bottle caps that act like stopwatches, counting the hour and minutes since the container was last opened. The caps, which became available in more than 1,000 pharmacies in 2012, are offered free of charge by most participating stores and sell for $4.95 online, says company founder Richard Burke.
Dr. Wolf, of Northwestern University, and other researchers, in partnership with the National Institutes of Health and the Agency for Healthcare Research and Quality, recently completed a trial testing a pill-bottle label that provides more explicit instructions and larger font size. The trial followed about 400 patients receiving diabetes and blood-pressure medications from a pharmacy in Washington, D.C., over the course of a year. About half the patients got the newly designed label and the rest received the standard one. Patients getting the modified label were two times as likely to take their medications as directed compared with those receiving standard labels, the study found.
Dr. Wolf says California in 2012 began requiring a label on prescription drugs similar to the one the researchers tested, and there is a push in New York to make similar changes.
Adherence is especially a problem for the elderly, who often have more complex drug regimens. Laura Bix, an associate professor of packaging at Michigan State University, published a small study in 2012 in online journal PLOS One that found young and old people look at pill bottles differently. Using an eye tracker, she found that college-age people rotate the bottles, enabling them to see all the informational stickers that pharmacists attach, whereas older people focus on just the bottle’s large white label.