Q&A: Wireless solutions for patient non-compliance

*David Rose, CEO of Vitality, on how wireless technology combined with social support can improve adherence rates*

David Rose, CEO of Vitality, on how wireless technology combined with social support can improve adherence rates

Poor adherence is a problem as persistent as it is widespread.

Despite rising awareness and support, patients continue to divert from their prescribed medicine plansand continue at rates that belie all the money and brainpower invested in the issue.

Connectivity can make a real difference.

A range of companies and entrepreneurs are harnessing technology to ensure that patients take their medicines properly.

WellDoc, for instance, has developed a cell-phone based platform that enables real-time, any-time communication between health providers, physicians, and patients.

Patients get reminders on their cell phones to take medication and have access to live coaches and wireless diaries. (For more on WellDoc, see Emerging wireless solutions for patient compliance.)

HealthHonors has developed software that analyzes individual patients and determines which incentives they respond to best: family support, competition, financial incentives, fear of death or ill health, etc.

The software creates a custom website that rewards patients with tailored incentives each time they take their medicines. (For more on HealthHonors, see Using incentives to improve patient compliance.)

GlowCaps, from the firm Vitality, is a solution that uses wireless technology embedded in the caps of patients medicine bottles.

When its time to take the medicine, the GlowCap lights up.

If the patient doesnt see or ignores the light for an hour, the cap plays a ringtone.

After two hours, the patient receives an automated call or text message.

David Rose, chief executive at Vitality, talked to eyeforpharma about how wireless technology, real-time feedback, and social support can boost patient compliance.


eyeforpharma: It seems that every year we hear about the enormity of the adherence problem and some new solution that's supposed to address it. Why is non-adherence such a pervasive and difficult problem?

David Rose: Non-adherence is multi-factorial. Each person has different, often multiple reasons for not taking a prescribed medication. Its not just a forgetting issue. Side effects, cost, non-belief, asymptomatic diseases, a lag in onset, refill coordination ... the eyeforpharma audience knows these issues. Our research counts at least 16 different barriers to adherence; many are subconscious. The Vitality solution works on 16 behavioral levers. We call it the motivational map.

How is GlowCaps different?

Our design process started with in-home ethnographic research to categorize the drivers of non-adherence. This process revealed a couple of key insights. We found that most people dont use day-of-the-week pillboxes to organize their medications, so we knew we must embed wireless technology and sensing into the standard bottles you receive from the pharmacist. Also, most people don't understand broadband or Wi-Fi, much less how to pair a Bluetooth device to a mobile phone, so an invisible cellular connection to the Internet was mandatory for broad adoption.

How does it work?

Today, people get a GlowCap with certain medications directly from their pharmacist. Its free. Its an opt-out program. And they see it as a standard packaging feature. The pharmacist just says, You get a GlowCap; it will call you so you dont forget to take this important medication.

At home, they plug in a Vitality night-light, which wirelessly connects up to 10 GlowCaps to the Internet through a cellular connection with AT&T. When its time to take the medication in the bottle, the GlowCap illuminates. If they havent opened the GlowCap within an hour, it plays ringtones to get their attention. If they still havent taken the medication after two hours, they receive an automated call or text message asking them why. If the reason is related to a refill, Vitality connects them to their pharmacist.

Each week they get an email showing their progress, copied to a loved one or buddy. Each month they receive a printed Vitality report, which may be sent to their caregiver. In some cases, there is an adherence reward or pharmacy coupon for exceeding a dynamic goal. The program blends multiple behavioral techniques: accountability to an authority, social support, competition, escalating reminders, and refill coordination.

How do you ensure that all this isn't overwhelming or over-intrusive to the patient?

Not every patient gets everything. There is a training period where Vitality asks a couple of questions with each phone, email, and Web interaction to build up a motivational profile. Based on this profile and baseline behavioral data, a unique combination of services is enabled for each person. For example, some are motivated by social incentives; others are more susceptible to financial incentives. Some prefer text messaging to automated calls. This personalization reduces the complexity of the system for each person and reduces overall program costs.

Deliberate non-adherence is another big factor in the adherence challenge. Does GlowCaps address this?

[GlowCaps] is able to measure real-time granular patterns of non-adherence to address behavior in the decisive moment. If the medical condition warrants, a nurse practitioner or transplant coordinator can pick up the phone and call a patient immediatelybefore bad habits calcify.

For example, if we detect deliberate non-adherence, we infuse education about the medication and condition into every touch point. Reminder and refill calls educate. The weekly emails include links to Web content and videos. Monthly printed Vitality reports include information about the mechanism of their disease and how prescribed medications can help. (For more on deliberate non-adherence, see How to address deliberate non-adherence. For more on the Web and adherence, see Using the Web to improve patient compliance.)

Are there studies that demonstrate GlowCaps' effectiveness?

Harvard measured a 27 percent lift in a recent hypertension study, from 71 percent to 98 percent. Thats an additional three months per year. We are working with six of the top pharma brands on programs now. With Vitalitys wireless technology, customers see results in real-time. They see adherence data sliced by geography, prescribing physician, and any patient demographic attribute that you can imagine.