As stated by the World Health Organization: “Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments” (WHO, 2003).
Understanding and improving adherence is one of the main objectives of the mHealth research group. This blog series will focus on different aspects of the relationship between prescription medication adherence and mobile technology in the pursuit of better health outcomes.
While there are a variety of reasons why medication adherence is important, a key aspect is that it affects the population on a national and international scale, regardless of the type of medication prescribed. For effective treatment, one must adhere to the treatment to obtain the health benefits (Brown & Bussell, 2011) – this is a symbiotic relationship.
- Health benefits
Among patients with chronic illness, approximately 50% do not take medications as prescribed (Brown & Bussell, 2011). Adhering to treatment regimens based on one’s prognosis is essential to suppress the decline of chronic conditions. Prescription medications need to be taken consistently to manage symptoms and treat disease. A major concern with medication adherence is the detrimental health effects (morbidity, mortality) associated with poor adherence. This is especially concerning for patients required to take medication for chronic disease, typically, daily. Our initial study WelTel Kenya 1 demonstrated that two-way weekly text messages not only improved treatment adherence but also lowered suppressed viral load for individuals with HIV going through antiretroviral therapy (Lester et al., 2010).
- Increasing costs
In 2014, $29.4 billion dollars were spent on prescription drugs (CIHI, 2016), and this number is expected to rise in the future. It is of economic value to hone in on adherence behaviours, especially with spending on prescription drugs being one of the top 3 costs to the Canadian health care system. While measures have been implemented to curb spending, costs continue to rise (CIHI, 2016). Increasing costs for prescription medication is not exclusive to Canada, and costs are rising in Kenya as well. Our recent publication found that SMS-based adherence interventions are cost-effective among individuals with HIV initiating antiretroviral therapy in Kenya (Patel et al., 2017).
- Patient engagement
Patient-centred care is a current buzzwords in health care. Medication adherence requires that the patient is motivated intrinsically to succeed. However, there are several barriers for patients to engage, such as stigmatization, fear, and lack of accurate information. It is necessary to provide patients with enough guidance on which strategies will help them achieve adequate treatment adherence. These strategies can ideally follow a comprehensive approach covering different parts of patient’s life including social, economic and family support. In fact, one of our studies in British Columbia found that HIV patients receiving the WelTel intervention found it to be a useful way of communicating directly with their health care providers. This increased access to support might boost the engagement in care (Smillie et al., 2014).
Identification of non-adherence is difficult and subject to change on an individual basis, depending on a variety of factors. Recognizing that medication adherence is not simply the responsibility of the patient, but rather a collaborative effort involving the care provider and an individual’s support network is key.
- Brown, M. T. & Bussell, J. K. (2011). Medication Adherence: WHO Cares? Mayo Clinic Proceedings, 86, 304-314.
- Canadian Institute for Health Information [CIHI]. (2016). Prescribed Drug Spending in Canada, 2016. Retrieved from https://secure.cihi.ca/free_products/Prescribed%20Drug%20Spending%20in%20Canada_2016_EN_web.pdf
- Lester, R.T., Ritvo, P., Mills, E. J., Kariri, A., Karanja, S., Chung, M.H., Jack, W., Habyarimana, J., Sadatsafavi, M., Najafzadeh, M., Marra, C.A., Estambale, B., Ngugi, E., Ball, T.B., Thabane, L., Gelmon, L.J., Kimani, J., Ackers, M., & Plummer, F.A. (2010). Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): A randomized trial. Lancet, 376, 1838-45.
- Patel, A.R., Kessler, J., Braithwaite, R.S., Nucifora, K.A., Thirumurthy, H., Zhou, Q., Lester, R.T., & Marra, C.A. (2017). Economic evaluation of mobile phone text messaging interventions to improve adherence to HIV therapy in Kenya. Medicine, 96, e6078.
- Smillie, K., Van Borek, N., Abaki, J., Pick, N., Maan, E.J., Friesen, K., Graham, R., Levine, S., van der Kop, M., Lester, R.T., Murray, M. (2014). A qualitative study investigating the use of a mobile phone short message service designed to improve HIV adherence and retention in care in Canada (WelTel BC1). J Assoc Nurses AIDS Care, 25, 614-25.
- World Health Organization [WHO]. (2003). Adherence for long-term therapies: Evidence for action. Retrieved from http://apps.who.int/iris/bitstream/10665/42682/1/9241545992.pdf