Medication adherence is essential in the treatment of older adults. Nonadherence to medication is a complex problem that can lead to exacerbations of chronic health conditions, hospital admissions, and other avoidable health care costs. Difanti e Souza and da Silva Santana (2013) reported that 33% to 69% of medication-related hospital admissions were due to nonadherence to prescribed medication treatments. Clients may fail to fill prescriptions, use more or less than the prescribed dosage, take the wrong medication, or use medications at incorrect intervals. Barriers to optimal medication adherence vary and may be intentional or unintentional (Hugtenburg, Timmers, Elders, Vervloet, & Van Dijk, 2013).
Older adults and those with chronic conditions, regardless of age, take multiple daily medications with varied frequencies, increasing the risk of medication errors or nonadherence to medication treatment. The purpose of this article is to examine strategies to assist these patients with medication management and adherence.
Traditional pillboxes were designed to assist older adults with their medication management. However, using them can lead to errors, particularly with complex medication regimens. Research has indicated that older adults achieved only 53% to 68% accuracy in the use of the prescribed medications with pillboxes (Difanti e Souza & da Silva Santana, 2013).
When use of basic pill organizers are not enough, some improvement can be achieved through the use of pill cases that include an alarm clock to maintain medication schedules. Another simple inexpensive pill dispenser with an alert, designed to help seniors stay safe with medication, is Dr. Dosage© ( http://drdosage.com). This device includes a mounted dispenser, loaded with stackable pods containing medications.
Technology to Improve Medication Management
It is impossible for a health care provider to be in the homes of all older adults with multiple comorbidities or chronic conditions. As hospitals increasingly focus on population health, the use of technology in patient homes is one approach to increase overall adherence with medications. The use of telehealth technology to connect patients from a distance can be a solution to increase access and decrease health care delivery costs (Persaud, Moffitt, Kravette, & DeRoss, 2013).
In one study (Hayakawa et al., 2013), a smartphone-based medication self-management system, with a real-time alert feature, showed improved medication adherence among the participants. The system studied had two major features. First, patients’ medication history in an accurate, accessible format was stored and maintained. Second, the system provided an electronic reminder when medications were missed. Data input included prescription data that are read using barcodes with a smartphone camera, together with photographic images of the medication. The system also provided real-time medication monitoring, with wireless pillboxes. Using a smartphone system was found to be acceptable to patients and supported medication self-management (Hayakawa et al., 2013).
For enhanced medication management, investment in an automated system with extra features can assist older adults to sustain their health and independence. For example, systems such as the e-pill® ( http://www.epill.com) automatic medication dispensers and organizers offer additional features to help ensure dispense of the right medications, the right dosage, and the right time for up to 28 days. These systems can reduce medication nonadherence by providing medication dispensers with various pill capacities, alerts, history logs, tamper-proof lock and keys, early dosage options, remote event monitoring, battery backup system, and care team member alerts when medications have been missed. Another type of medication administration station is the four-alarm, locked, automatic pill dispenser, with tipper and dispensing cup for all medications. The e-pill manufacturer also offers the CADEX 12-alarm watch and medication reminder. The watch provides alerts and reminders, with the name of the medication to be taken displayed on the watch face. The medical alert feature can display allergies and appropriate contact information in the event of an emergency. The e-pill products vary in cost, based on the available options, but do not have monitoring fees.
The MedMinder™ ( https://www.medminder.com) medication management system includes an electronic pill dispenser, which reminds users to take their medication on schedule, using various visual and auditory alerts. When users have not taken their medications, designated caregivers can be notified in real-time via telephone, e-mail, text message, or a combination of these. If medications are taken on time, no alerts are sent. Other features include locked pill dispensers, a medical alert system, a cellular connection, a multiweek feature, refill trays, and custom greetings that can be recorded by caregivers. Custom messages can be set as medication reminders. Multiple care team members can be notified via their preferred notification preferences. Each pill cup holds 11 to 12 average-sized tablets. In addition to these features, weekly and monthly reports can be generated to monitor medication adherence. The MedMinder is the only pill dispenser that has its own built-in cellular connection; therefore, the system can be used without a telephone line or Internet connection. The MedMinder system does not have a purchase cost, but monitoring fees range from approximately $40 to $65 per month, depending on the model and features.
Student Telehealth Feasibility Project
Through a U.S. Department of Agriculture Delta grant, students in the authors’ community nursing course participated in a feasibility study, which assessed the use and evaluation of technology to promote health in community-dwelling older adults. They found that automated pill dispensers, such as the MedMinder system, were easy to set up and allowed the team to participate in the medication management from a distance using the notification and report features. Technology allowed the students to provide a multifaceted approach to help clients remember to take their medications. Costs related to monthly monitoring fees, the use of newer technology, and the process of filling the pill dispenser could be ongoing challenges. The telehealth project team recommended that future telehealth projects include extending the length of use, standardized pre- and postintervention questionnaires, and involvement of additional caregivers.
Recognizing medication non-adherence and tailoring devices for the patient’s cognitive and physical abilities could decrease medication-related hospital admissions. Telehealth is a new concept in health care. It is imperative to consider not only the potential benefits but also the challenges, such as ease of use, cost, and cellular connectivity.
- Difanti e Souza, F.R. & da Silva Santana, C. (2013). A descriptive study about the use of pillboxes by older adults. Health, 5(12A), 103–109. doi:10.4236/health.2013.512A014 [CrossRef]
- Hayakawa, M., Uchimura, Y., Omae, K., Waki, K., Fuita, H. & Ohe, K. (2013). A smartphone-based medication self-management system with real-time medication monitoring. Applied Clinical Informatics, 4, 37–52. doi:10.4338/ACI-2012-10-RA-0045 [CrossRef]
- Hugtenburg, J.G., Timmers, L., Elders, P.J., Vervloet, M. & Van Dijk, L. (2013). Definitions, variants, and causes of non-adherence with medication: A challenge for tailored interventions. Patient Preference and Adherence, 7, 675–682. doi:10.2147/PPA.S29549 [CrossRef]
- Persaud, N., Moffitt, G., Kravette, K. & DeRoss, A. (2013). Usability and benefits of a telehealth pilot for older adults: Via a service-learning technology partnership. Communications of the IIMA, 13(4), 43–53.