High-Tech Pill Nags

  1. pill reminders at our age? alarming!
    high-tech time-for-your-dose nags are light years beyond your parents' plastic pill box

    by francesca lunzer kritz
    special to the washington post
    tuesday, january 15, 2002; page he01

    since getting his scary cholesterol level results this fall, my husband, neil, 43, has been vigilant about taking his lipid-lowering drug. well, he's vigilant monday through friday. on the weekend, his habit of grabbing the pill as he runs out the door in the morning gets lost in his very different saturday and sunday routines.

    turns out he has lots of company. drug compliance, or sticking with a drug regimen, eludes about half of all people who get a prescription, says jerry avorn, an associate professor of medicine at harvard medical school and chief of the division of pharmaco-epidemiology at brigham and women's hospital in boston.

    but while studies on noncompliance have often focused on elderly patients taking drugs for acute conditions accompanied by pain or depression, avorn says medical attention is turning to a new and burgeoning group: largely healthy men and women age 30 and up taking drugs to control an asymptomatic condition or to ward off an ailment they don't yet have. this means people taking cholesterol-lowering drugs, daily aspirin to prevent a heart attack, thyroid hormone, blood-pressure-lowering drugs, some asthma medications, antidepressants and some other drugs that need to be taken regularly and long-term -- for conditions that do not produce an acute symptom like pain to remind a user about a skipped dose.

    but the absence of symptoms isn't the only reason people skip doses.

    "being a very busy person is the single biggest risk factor we found," says denise park, lead researcher of a 1998 university of michigan study on noncompliance.

    but lapses in drug regimen may also be triggered by worry over side effects, reluctance to acknowledge a potential illness, anger over getting older or a desire to hide medicine use from colleagues, according to joyce cramer, a yale psychology lecturer on the subject. and while poor compliance is often considered an older patient's problem, the michigan researchers found that compliance rates for those over 55 (47 percent) were nearly twice those for people between the ages of 34 and 54 (28 percent).

    but whatever the reason, there's a host of new high-tech solutions being proffered, many of them gizmos as far removed from your parents' plastic dollar-store pill box as your imac is from your ballpoint. the gadgets -- which promise convenience, style and, sometimes, discretion -- include watches and clocks that can be set to ring, vibrate or light up when it's time to take your meds, pager and cell phone messages that display timely dosage reminders, software for your personal digital organizer and, for a mere $800, a sleek coffee-machine-looking device that can be timed to dispense multiple drugs in a neat little pill cup.

    where they're displayed -- occasionally in pharmacies, but more often on the web -- also speaks to the target market for these devices. "we put a web site full of high-tech reminder products on the internet three years ago," says stefan solvell, president of epill.com, the web's largest medication reminder company. since then, he says, sales have tripled. "before that, reminders were generally sold in medication supply stores that also sold commodes and walkers."

    here's a look at some of the products available -- rarely covered by insurance. for further information, see the list at the end of the story.

    * the cheapest and easiest-to-use device is probably epill's "once a day," meant for people who take only one drug each day, as i do with thyroid hormone and my husband does with his statin. it looks like a midget oven timer. the way you're supposed to show you've taken your daily dose is by turning the dial to the current day of the week. it didn't work for us. our mistake, says solvell, was placing our two once a days inside our kitchen drug cabinet rather than in a more prominent place, like a car dashboard or refrigerator door. for those reticent about broadcasting their medicine needs, this may not be the right solution.

    * if you need a more animated reminder, you might consider one of a number of multiple-alarm watches that ring, beep or vibrate when it's time to take your drug. epill's six-alarm version -- it can be set to remind you of up to six different dosing times during the day -- costs about $100 and boasts a look sleek enough for discretion (at least until it rings or vibrates mid-meeting). like most of the alarm-feature devices, the watch needs no adjusting once it's set, unless you change your medication schedule. barbara borodach, a rockville homemaker, credits a similar five-alarm watch, which her physicist husband found when they were on a business trip last spring, with helping her take all doses of her glaucoma medication and prevent progression of the disease.

    * another device that can alert you to med time may already be in your briefcase -- your personal digital assistant. several companies make software that can be installed on your pda, which then beeps or lights up when it's drug time. one such program by on-time-rx rings you again if you fail to let it know you've taken the drug. at $30, it's a bit more expensive than two other pda software programs -- medtime 1.3 ($10) and pillpal ($5) -- but on-time-rx can also keep a log of your regimen and compliance statistics.

    however devoted you are to your palm, though, you may also need a different reminder on the weekend. "come friday, that pda stays in my briefcase in the closet and there's no hope of my hearing an alarm go off," says raymond woosley, vice president of health sciences at the university of arizona and formerly head of clinical pharmacology at georgetown university medical center. woosley's solution is to leave his pill vial by his toothbrush -- a useful tip if you don't need to take pills more than, say, two or three times daily.

    * unlike the devices mentioned above, which assume you've remembered to take your pill vials with you, medglider is a $17 gadget that combines both an alarm and a plastic sleeve that can hold a day's supply of drugs. herman wood, a baltimore retiree who used to forget to take his twice-daily medicine for the skin condition rosacea, swears by the device, which his wife found at giant. for about $10 more, you can buy a seven-sleeve kit -- as wood did -- that needs filling once a week. each day's sleeve has four compartments with room for several pills each, so people can use it to take drugs up to four times a day. when wood was recently prescribed a cholesterol-lowering drug, he added it to the medglider and says he never misses a dose. "i'm so grateful to my wife, i bought one for her father," he says.

    the md.2, that coffeemaker-like device, also works as both alarm and dispenser, but its $900 price tag and its ability to dispense six pills at a time, up to six times per day, likely makes it overkill for anyone but those with the most complicated drug regimens.

    * if you'd just as soon carry the whole darn bottle with you each day, you might be interested in a california company's invention: a $95 bottle cap (you provide the bottle) that records when you last opened it and took your latest dose. it's used at medical centers around the country to give clinical trial researchers reliable data on patient drug compliance.

    * for those who prize discretion -- privacy is a popular request, say experts -- there are a few choices: epill's solvell says many of his customers opt for the vibrating mode on the watch, "so that no one in the room knows they've been signaled to take their medicine." pager systems sold through various sites including medreminder.com let you design a coded message, such as "your nine o'clock appointment is waiting," for delivery every morning. pager and cell phone service runs about $15 a month.

    if you don't want to be left to your own, um, devices, consider a service about to be launched by grubb's pharmacy, an independent drugstore on capitol hill. for $15 per month, grubb's will give you a phone call as many times per day as needed to match your medication schedule. the computerized interactive system requires you to punch in information, such as whether you've taken the pill. at month's end, the pharmacy can use the data generated to counsel you, if necessary. grubb's ed dillon says the service was developed to help those with chronic conditions, such as hiv, but could be a boon to others as well.

    after all this, if you're still failing to take your medication, you have two basic options. first, try talking to your pharmacist. a long-term project by the american pharmaceutical association found that pharmacists who counseled cholesterol drug patients monthly and administered blood tests to show the change produced by the drug, doubled patients' compliance levels when compared with patients who didn't get counseling. or ask your doctor to switch you to a drug with an easier dosing schedule, if one is available. for example, fosamax, an osteoporosis drug, is now available in a once-a-week dose.

    as for my husband, bells and beeps have never been a part of his daily routine but he now tries very hard to head for the drug cabinet first thing on weekend mornings just as he does during his workweek. and he has a failsafe: our kids, ages 6 and 9. they have proven quite reliable in reminding him to take his pill, and while they're not exactly programmable, they have a whole lot more to gain by keeping him compliant than do the makers of the high-tech devices.

    francesca lunzer kritz is a regular contributor to the health section.
    2002 the washington post company

    one elderhealth company has a private pay medication service ----rn will come to your home weekly to 2x month and refill electronic med container and do eval for med side effects.
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