Medication compliance, or adherence, has been described as a patient's actions regarding medication administration that are in accordance with medical advice.1 According to former Surgeon General C. Everett Koop, "Drugs don't work in patients who don't take them." Compliance with or adherence to a medication takes into account not only whether the medication was taken, but also whether it was taken as prescribed. Some common types of noncompliance include not filling the prescription, taking too much or too little medication, not taking the medication at the right time, missing doses, and stopping the medication without medical advice.2 Therefore, medication compliance is often measured according to the percentage of doses taken, the percentage taken correctly, and the number of days per month that the medication was taken appropriately.2
A review conducted by Krueger et al showed that a decrease in compliance was attributed to medication cost increases, treatment duration, number of medications, and severity of adverse drug events.3 On average, patients take approximately 75% of their prescribed doses when diverse disease states are being treated.4 For once-daily medications, compliance rates range from 80% to 95%.2,4 As the number of daily doses increases, adherence to the medication therapy and proper administration times declines.4 Approximately 200,000 deaths are caused by medication errors each year.5
Current Interventions
Prior to the development of other compliance aids, many prescribers mitigated high-frequency medication regimens by employing once-daily and twice-daily dosing.6 Various aids have been tested as a means to improve patients' medication adherence. Compliance aids are often grouped into the following categories: adherence aids, refill reminders, regimen simplification, instructional materials, and comprehensive management.3 On average, compliance interventions have been shown to increase adherence anywhere from 6% to 25%.3 Of the multiple compliance aids available, memory cues and pillboxes are more commonly used. Memory cues or aids include telephone reminders, timed alarms, and automated pillboxes.
Remote Medication Management System
INRange's Electronic Medication Management Assistant (EMMA) is an in-home medication-management tool for high-risk patients with complex disease states, polypharmacy management needs, and chronic medications that require frequent adjustment. It is the only FDA-approved medical device for remote management of medications (FIGURE 1).7 Unlike other compliance aids, EMMA is a Web-based system that is equipped to select and deliver medications according to the prescriber's directions. Physicians and pharmacists can remotely schedule medications and alter dosing intervals. EMMA is designed primarily to sort medications, reorganize them with schedule changes, and deliver the right medication at the right time. Family members or home nurses can then care for the patient without the worry of medication management.
EMMA can store a month's supply of up to 10 medications per unit.7 If the patient has been prescribed more than 10 medications, several units may be linked together. The system allows for compliance monitoring and real-time dose adjustments through its wireless software capabilities. It maintains the patient's complete medication history and provides clinicians with vital information about medication dosing, adjustments, refills, missed doses, and treatment responses. Additionally, vital information may be transferred to the patient's electronic medical record with reliable data security. EMMA can reduce the associated costs of medication mismanagement at home and prevent injuries caused by administration errors.
How the System Works
In the EMMA system, medications are packaged and dispensed in a blister card. Bar-code technology is used to identify the different medications. The patient's dosing schedule is programmed by the pharmacist or physician during the pharmacy or office visit. The dispensing and labeling of the prescription remain essentially the same. The prescription label for the blister cards can be printed using Web-based software to ensure accurate product identification. Once the pharmacist checks the prescription, the label is affixed to the back of the blister card, similar to labeling a prescription vial.
At home, EMMA gives a visual and audible alert when it is time for a medication to be administered. After the alert, the patient can activate the system and dispense the correct medications into the attached tray.
FIGURE 2 illustrates how the EMMA system can be integrated into the current system of medication dispensing.8
Benefits and Special Features
Besides ensuring accurate dosing and allowing for real-time dosing adjustments, the EMMA device has many other potential advantages. Some of the system's key benefits are highlighted in TABLE 1.7
Some unique features distinguish EMMA from other compliance aids. These include the management of scheduled prescriptions, OTC medications, and as-needed medicines; user-friendly touch-screen activation; wireless services for accessing patient responses and transmitting medication changes; interfacing capabilities for updating electronic medical records; and tracking abilities for creating an electronic medication-administration record. The unit also allows advance delivery and administration of medications when the patient will be away from home (vacation, restaurant visits, etc.).
Future Directions
The EMMA device has been designed to assist individual patients, as well as those in home health programs and long-term care facilities, with their medication needs. The system is being upgraded with technology that allows for medication reconciliation, accommodation of multiple users (family use), and expanded storage of up to 20 medications. Studies examining EMMA's clinical and economic efficacy with regard to chronic medication management are being conducted.
Conclusion
As the population continues to age, patients will be receiving an increasing number of medications. Adherence to medication regimens typically declines as the number of prescribed medicines increases. InRange's remote medication-management system is a simple, user-friendly approach to managing the dispensing and administration of numerous medications and helps increase medication compliance. For more information, contact INRange Systems, Inc., at (814) 940-1870.
REFERENCES
1. McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA. 2002;288:2868-2879.
2. Lococo KH, Staplin L. Factors affecting compliance with medication regimes: medication-related factors.
www.nhtsa.dot.gov. Accessed March 18, 2008.
3. Krueger KP, Felkey BG, Berger BA. Improving adherence and persistence: a review and assessment of interventions and description of steps toward a national adherence initiative. J Am Pharm Assoc.
4. Cramer JA. Effect of partial compliance on cardiovascular medication effectiveness. Heart.
5. Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc. 2001;41:192-199.
6. Nunney JM, Raynor DK. How are multi-compartment compliance aids used in primary care? Pharm J. 2001;267:784-789.
7. EMMA product information. Altoona, PA: INRange Systems, Inc; 2008.
8. INRange Systems, Inc. Creating a new standard of care for outpatient treatment.
www.inrangesystems.com. Accessed May 14, 2008. 2003;43:668-679. 2002;88:203-206.
To comment on this article, contact rdavidson@jobson.com.
