David Rose- CEO, Vitality, Inc.
Take as directed. Three simple words that have proven very difficult to follow.
The Journal of General Medicine reports that 1 in 5 prescriptions never get filled. For those that do, breakdowns in medication adherence are rampant. Patients take their meds irregularly then suffer the consequences. For those recovering from a transplant or with diseases like HIV or Hep C, those consequences can be swift and fatal. For Americans with chronic conditions (which is now about 44% of us), forgetting to take our meds means hospitalization, poor medical outcomes and a multi-billion dollar price tag we all share.
But why is this? And what can we, as healthcare executives and innovators, do?
Today’s medications are safer than ever. They are powerful medications that have been researched for over a decade at a cost of hundreds of millions. They’ve been through FDA processes to ensure that they’re safe and effective and they’re prescribed by our doctors who learn about them in medical school or after. And yet in spite of the development, testing, distribution and education costs—this last mile problem persists. People still don’t take their meds regularly.
It’s not just forgetfulness.
For decades, psychologists have studied and tested ways to motivate people to change behavior. Specifically, they’ve examined behavioral changes like weight loss or smoking cessation where the change occurs over the course of many decisions patients must make every day. It turns out, we’re not all the same. Different people are motivated by different things. For example, many people are driven by the approval of authority figures. But not me. If my physician tried to get me to change by using his position of authority, it wouldn’t work. But if he tried a different tactic, maybe a financial incentive or pressure from my friends or patients-like-me, I’d be much more likely to shape up.
Taking a medication is an every single day (and sometimes twice-a-day) decision. When we look for reasons that these decisions fail (ie. why patients fall off their treatment regimen), the literature says that part of the cause is forgetfulness. But another large part has to do with people’s belief in their medication, their understanding of what the medication does inside of their body. For many, the process of getting refills is complicated and arduous. Any approach to improving medication adherence has to address both the reasons why patients are falling off the path as well as the specific ways patients can be motivated every day to get better.
Personalization saves costs.
You don’t want to lose money and time on prescribing things for people where it’s not going to be effective. This is where technology comes in. We now have a huge set of new communication tools at our disposal to create positive feedback loops to sense people’s activity and motivate daily change. We can use really cheap wireless devices to monitor a patient’s activity and share that data with a professional coach, a doctor, or someone the patient designates as a supporter.
We can use the same statistical techniques that Netflix uses to recommend movies, and instead use them to pair each patient with the motivational style that works for them: social incentives for some, financial incentives for others, educational prescriptions for still others. We can tweak the messaging and tone we use in automated phone calls and emails so that they resonate with each specific patient. And if we do, we can see adherence jump from 50% to 75% or even 90% which is what Harvard University found in a recent study of these integrated techniques.
“Take as directed” is too hard for most of us.
Decades of pharmaceutical research isn’t useful if most people are non-adherent to their doctor’s orders. We need the help of modern psychology and ubiquitous technology. We need the support of friends, family, a coach or perhaps a financial incentive. Most importantly, we need a solution that’s tailored for each of us.
David Rose is an entrepreneur and the Chief Executive Officer at Vitality, a company that creates internet-connected pill caps. Vitality GlowCapsTM illuminate, play a melody and even ring a home phone so patients don’t forget their meds. Besides creating smart medication packaging, David is the inventor on many patents including online photo-sharing, interactive television systems and ambient information displays. He has degrees from Harvard and St. Olaf College; he teaches a popular course at the MIT Media Lab, and he lives in Brookline, Mass with his wife and two young children.
