Improving medication adherence through technology: analyzing the managing meds video challenge

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1 Skin Research and Technology 2014; 20: Printed in Singapore All rights reserved doi: /srt John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Skin Research and Technology Improving medication adherence through : analyzing the managing meds video challenge Matthew S. Laffer 1 and Steven R. Feldman 1,2,3 1 Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA, 2 Department of Pathology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA and 3 Department of Public Health Sciences, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA Background: Poor adherence to medication is an enormous problem. While many measures to improve adherence have been proposed, patients may be a good source of novel approaches. The Managing Meds Video Challenge was designed, by the U.S. Department of Health and Human Services (HHS), in collaboration with the National Consumers League Script Your Future campaign, for patients to create short videos containing ideas on how to better take medications as directed. Purpose: Determine what forms of patients use to help adhere to their medication regimens. Methods: The 17 available videos from the Managing Meds Video Challenge were analyzed to determine what forms of patients use to help adhere to their medication regimens. Results: Approaches to improve adherence included calendar and reminder applications, and third-party applications such as MedCoach Medication Reminder, Walgreens Pharmacy, and CVS/Pharmacy. Patients also improved adherence by using the Internet to access websites such as com to manage medications, access electronic health records, and to order medications from online pharmacies. Limitations: This study only analyzes the 17 available videos from the Managing Meds Video Challenge. Conclusions: Patients are using a variety of to manage their medications. They appear to rely primarily on reminder systems. Key words: mobile apps text message treatment internet compliance Ó 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Accepted for publication 3 May 2013 A DHERENCE TO a medication is defined as the extent to which patients take medications as prescribed by their health care providers (1). Patients lack of adherence to medication regimens is an enormous problem in the U.S., as approximately 125,000 patient deaths, at least 10% of hospitalizations, and 23% nursing home admissions are directly related. Non-adherence also has a negative financial impact on society, costing the U.S. health care system more than $100 billion annually (2). To increase adherence, the Office of the National Coordinator for Health Information Technology ( ONC ), part of the U.S. Department of Health and Human Services (HHS), in collaboration with the National Consumers League Script Your Future campaign, created the Managing Meds Video Challenge. This Challenge was designed to have patients themselves, provide ideas that would improve patient health and safety. In short videos, patients demonstrated how one uses to manage medications or help others take medications as directed. The hope of the Managing Meds Video Challenge is that the videos will motivate others to use health information to support effective medication management (3). Patients may be in a good position to know what type of will best help them adhere to treatment plans. By reviewing the videos in the Managing Meds Video Challenge, we hoped to identify approaches that patients think would be useful to help themselves with adherence. Methods The Managing Meds Video Challenge was designed to provide recognition to contestants who created inspiring and instructive videos 62

2 Improving medication adherence that share how individuals can use health information to manage meds effectively and improve health and safety (4). The patients were asked to create videos no longer than 2 min, displaying how health information can support effective medication management (4). The contest had 21 video submissions, but currently there are only 17 working videos on the contest website. For this analysis, 17 available videos were watched to determine what forms of patients are currently using to help adhere to their medication regimens. Results The 17 available videos from the Managing Meds Video Challenge demonstrate patients using a variety of health information (Table 1). A common theme throughout the videos is that patients rely heavily on their cellular phones. 16/17 videos in the Managing Meds Video Challenge discuss or display a cellular phone. Owning a smart or basic cell phone allows users to access a variety of built-in and downloadable applications that can be used to increase adherence to medication. In the 2-min patient created videos, 14 of the 17 videos (Table 2) mentioned using a cellular phone alarm, calendar or reminder application. To set a reminder, a patient can use the applications that come standard on most cellular phones, or download third-party applications from an application store. When using a basic calendar or reminder application, the patient selects when they would like to be reminded to take their medications. For patients who have an Apple Iphone with Siri, the built in personal assistant, a patient can ask Siri to be reminded to take their medication at a specific time. Multiple videos demonstrated that thirdparty applications, applications that can be used on a patient s cellular phone but were not designed by the cellular phone provider, can be used to promote adherence. These third-party applications can be downloaded from an App Store such as Google Play for Android Phones, or Itunes for the Iphone. In the Managing Meds Video Challenge, patients specifically mention the MedCoach Medication Reminder application, which is a free application available to download on multiple mobile devices. MedCoach alerts the patient TABLE 1. Technology exhibited in available videos Video title Remind me again! Managing your meds with mobile Manage your meds for free with google calendar! Manage meds with a smartphone Manage your health with Improving adherence with a healthy dose of Managing meds using A healthier you Agent ooo - licensed to cure Managing meds: working inter-professionally to reduce barriers to med adherence The game of MANAGE Unpacking day Marshall s medication Using QR codes to manage your meds A day in the life My medication app continues to save the day Managing meds through an internet pharmacy *All videos mention Technology exhibited -Basic cellular phone functions: alarms -Ipharmacy application -Rememberitnow.com -MedCoach application -Walgreens pharmacy application -Google calendar -iphone reminders using Siri -Pill reminder application -Message physicians online -CVS pharmacy application -Smart phone electronic calendar -Healthy dose radio show -Online tools -App stores -Smart phones -Mymedschedule.com -Cellular phones: lists, reminders -Cellular phones: reminders, calendars -Prescription refill applications -Online pharmacies -Electronic health records -Electronic prescriptions -Smartphone reminders -Desktop computer reminders -Electronic health records -Applications -Electronic prescriptions -Mobile applications -Electronic heath records -Cellular phone alarms -Internet websites Scriptyourfuture.org -Basic cellular phone functions: alarms -Smartphone applications -Google goggles application -Video calls -iphone reminders using Siri -Cellular phone applications -Online pharmacy 63

3 Laffer et al. TABLE 2. Total number of adherence interventions Adherence intervention Basic cellular phone alarm 3 Cellular phone applications 12 Electronic health records 3 Electronic prescriptions 2 Google calendar 1 Internet websites 3 Google goggles application 1 Iphone reminders using SIRI 2 Video calls 1 Desktop computer reminders 1 Online pharmacy 2 Healthy dose radio show 1 Number of videos when it is time to take their medication, documents when they took their medication, connects to a patients pharmacy to refill prescriptions, and can be used to look up drug information (5). Patients can also download free third-party applications designed by their pharmacy. The Walgreens mobile application permits patients to refill prescriptions previously filled at a Walgreens pharmacy by simply scanning the barcode on their prescription bottle. Patients can receive notifications to refill a prescription, access their prescription history, transfer prescriptions to Walgreens, and schedule medication reminders on their mobile phones (6). CVS/Pharmacy has a similar free application that allows patients to scan prescription bottles for instant refills, transfer and manage prescriptions, and access their prescription history (7). Patients are also using applications such as IPharmacy Drug Guide & Pill ID, which allows them to identify their medication by brand name, generic name, color, shape, imprint, and bar code. This application also has features to help patients maintain a medication schedule and compare prices at multiple pharmacies (8). From a cellular phone or home computer, patients can use the Internet to sign up for a free Google account that will give them the ability to create a Google Calendar ( google.com/calendar). In this online calendar, patients can set daily events to remind themselves to take their medications. Patients will receive reminders on their desktop, via Short Message Service (SMS) Text, or via . There are a variety of other websites patients are using to help improve their medication adherence. At patients can manage medications, document personal medical history, receive mobile reminders, maintain a health journal, and track blood pressure and blood sugar. At www. mymedschedule.com, patients can create medication schedules, receive text or reminders, set prescription refill reminders, and organize prescription drug history. At www. scriptyourfuture.org, patients can create medication lists, learn how to use medications safely, and set medication reminders to be sent to their cellular phone. The website nih.gov/ helps patients identify unknown solid pharmaceuticals. Patients can also view highresolution images to identify capsules and tablets by imprint, shape, color, size, and scoring. At up-to-date information can be found about their current or past medications. Patients also noted in their submissions that it is easier to monitor their health and adhere to a medication regimen when given easy access to their physicians and medical records online. Contacting their physician through an online messaging system or video chat, allows patients to have their questions answered from the comfort of their own home. Having the ability to access their medical record through an electronic health record permits patients to better understand their medical history and view their active prescriptions. Receiving electronic prescriptions also increases patients adherence. Physicians can electronically prescribe prescriptions to a pharmacy of the patients choice. Sending prescriptions electronically prevents pharmacist errors, decreases drug interactions, and the pharmacy will likely have the prescription waiting when the patient arrives to pick it up. Patients are also ordering their medications from online pharmacies. These pharmacies will ship the medications to the patients house, which can be especially valuable to patients who have difficulty driving or finding a ride to the pharmacy. While purchasing medications from online pharmacies, patients can also sign up for prescriptions to be automatically refilled and shipped, as well as receive reminders to renew prescriptions. One video submission featured a radio show titled Healthy Dose, which is a weekly radio program offering advice on disease treatment and prevention from professionals at Samford University s McWhorter School of Pharmacy ( A 64

4 Improving medication adherence submission also featured the Google Goggles application to scan Quick Response (QR) bar codes. Physicians can attach QR codes to sample medications that contain their website and contact information that the patient can access with this application. In addition, each submission in the contest also mentioned the government website and directed viewers to the website. Discussing this website was a requirement for submission of a video in the contest. Discussion Previously, investigators have performed multiple studies to determine the impact of SMS text reminders on patients adherence to medication regimens. Vervloet et al. concluded that type 2 diabetic patients who received SMS reminders to take their oral medication took significantly more doses within 1 and 4 h of receiving a message when compared with patients who did not receive reminders (9). Strandbygaard et al. discovered similarly positive results, as asthmatic patients who receive a daily SMS reminder on their cell phone remember to take, on average, about 18% more doses of their antiasthmatic medication compared with asthmatic patients who do not receive such an SMS reminder (10). From these studies one can see that using can have a positive effect on patients adherence. From our analysis of the Managing Meds Video Challenge, we were able to determine that patients are using a variety of to manage their medications. The main forms of patients appear to rely on are primarily reminder systems. Patients are using multiple platforms for reminders including: basic cell phone alarms, calendars, or thirdparty reminder applications. Patients are also using electronic prescriptions and online pharmacies to ensure that they have medication that is easily accessible. In addition, patients are using the Internet and computers with the goal of finding websites that can help them take their medication as directed. All patients also demonstrated their ability to use gov, however, as this was a requirement of the contest, it is difficult to determine if patients are actually using tools available at this website. Another limitation of this study is that as this was a contest focused on the Internet, it selected for patients who may use electronics more than others. It is important to realize there are still other methods of adherence patients use that are non-electronic based. With this information, further studies should be completed using the patients are currently using, as seen in the Managing Meds Video Challenge, to conclude which type of can have the greatest impact on patient adherence. Conclusions Patients are using a variety of to manage their medications. They appear to rely primarily on reminder systems. There are many available reminder systems including basic cellular phone alarms, calendars and downloadable third-party applications. Acknowledgements The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. Dr. Feldman is a consultant and speaker for Galderma, Stiefel/GlaxoSmithKline, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, and Bristol Myers Squibb. Dr. Feldman has received grants from Galderma, Astellas, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, Coria/Valeant, Pharmaderm, Ortho Pharmaceuticals, Aventis Pharmaceuticals, Roche Dermatology, 3M, Bristol Myers Squibb, Stiefel/ GlaxoSmithKline, Novartis, Medicis, Leo, Han- All Pharmaceuticals, Celgene, Basilea, and Anacor and has received stock options from Photomedex. Matthew Laffer has no conflicts to disclose. References 1. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005; 353: Peterson A, Takiya L, Finley R. Meta-analysis of trials of interventions to improve medication adherence. Am J Health Syst Pharm 2003; 60: Managing Meds Video Challenge. Available at challenge.gov/. Accessed March 28,

5 Laffer et al. 4. Managing Meds Video Challenge, Rules. Available at Accessed March 28, Google Play, MedCoach Medication Reminder. Available at google.com/store/apps/details?id= com.greatcall.medcoach&hl=en. Acc essed March 28, Google Play, Walgreens. Available at apps/details?id=com.usablenet.mo bile.walgreen&feature=search_resu lt#?t=w251bgwsmswyldesimnv bs51c2fibgvuzxqubw9iawxllnd hbgdyzwvuil0. Accessed March 28, Google Play, CVS/Pharmacy. Avail able at store/apps/details?id=com.cvs.lau nchers.cvs&feature=search_result#? t=w251bgwsmswyldesimnvbs5j dnmubgf1bmnozxjzlmn2cyjd. Accessed March 28, Google Play, IPharmacy Drug Guide & Pill ID. Available at play.google.com/store/apps/detai ls?id=com.sigmaphone.topmedfree &hl=en. Accessed March 28, Vervloet M, Van Dijk L, Santen- Reestman J, Van Vlijmen B, Van Wingerden P, Bouvy M, de Bakker D. SMS reminders improve adherence to oral medication in type 2 diabetes patients who are real time electronically monitored. Int J Med Inform 2012; 81: Strandbygaard U, Thomsen S, Backer V. A daily SMS reminder increases adherence to asthma treatment: a three-month follow-up study. Respir Med 2010; 104: Address: Steven R. Feldman Department of Dermatology Wake Forest School of Medicine Medical Center Boulevard Winston-Salem NC USA Tel: Fax: sfeldman@wakehealth.edu 66