Web Technology Helps Ensure Patients Take Their MedicineWeb Technology Helps Ensure Patients Take Their Medicine

Clinical drug-study processes, as well as overall requirements for compliance with prescribed medication, are being intensely scrutinized with the recall in October of arthritis medicine Vioxx and recent testimony by a government scientist suggesting that at least a half-dozen other commonly prescribed medicines also pose health risks. New Web-based monitoring and drug-dispensing devices could help improve accuracy in clinical drug trials, as well as improve outpatients' medication compliance in everyday life.

A Web-based medication-monitoring device from InforMedix Holdings Inc. is being piloted in a handful of programs to help track and improve patient medication compliance. InforMedix' Med-eMonitor device combines an electronic patient diary and medication dispenser. The videocassette-sized device includes five drawers that can each hold about a month's worth of pills, and produces an electronic time-stamp each time a drawer is opened. The device features alarms to remind a patient that it's time to take a drug dose, and a display screen provides a patient with instructions, such as how many pills to take, as well as prompts for a patient to answer questions, such as how he or she feels, and provide other specific information. If a patient misses a dose or is about to take a dose too soon after the last dose, the Med-eMonitor will display an alert.

The Med-eMonitor features a phone-line link, or "cradle," for patients to download their information to a secure InforMedix database, from which doctors or researchers can monitor how patients are doing with their medications. Messages from the doctors to the patients also can be uploaded onto the Med-eMonitor.

St. Vincent Healthcare, which provides health-care services to patients in a 500-mile radius stretching from Montana to parts of Idaho, North and South Dakota, and Wyoming, will kick off this month a pilot program for 20 diabetic patients living in remote rural areas. "Some of these patients are more than 200 miles away," says Doris Barta, St. Vincent grants manager. Patients in the study will be equipped with Med-eMonitor devices for their diabetes medicine.

The telehealth disease-management program aims to track and improve the compliance of these remote patient's with their medicine protocols and the status of their ailments. Glucose readings taken with a separate device are entered into the Med-eMonitor so that doctors can track blood-sugar results with the timing of medication.

The daily transfer of information to the patients' doctors can help the physicians provide earlier intervention if patients experience health problems that might otherwise be forgotten or not reported for several weeks or months. Because these patients live far from St. Vincent's facilities, the device monitoring also can reduce the amount of travel they must make for office visits, because doctors can monitor their condition and compliance remotely, Barta says.

"Too often, we presume a patient is taking their medication; however, they may have stopped taking it because they feel better," says Bonne Farberow, a registered nurse and a project manager at the Division of Cardiology at the University of Pennsylvania. The University of Pennsylvania frequently collaborates with St. Vincent on telehealth programs, including the Med-eMonitor pilot. Other times, "patients will self-medicate," for instance, taking a drug or increasing dosage without the advice of a physician, Farberow says.

Under the St. Vincent program, doctors will prescribe a regime, including the diabetes medication, for each patient. The prescription is filled by drug distributor McKesson, a partner in the pilot. The medicine gets loaded into the device, which is programmed with instructions and alerts specific to that patient.

Typically, patients download the information once a day. However, in the case of the diabetes pilot, patients will be instructed to download the information each time a glucose reading hits a troublesome level. If a blood-sugar level is too low, the device will instruct the patient to take a glucose pill, and then alert the patient to take an additional blood reading shortly thereafter. The patient is instructed to download that information as well.

After the completion of the initial St. Vincent pilot, likely next year, the University of Pennsylvania will expand that program into "phase two" of the project, which will include about 320 diabetic patients in Pennsylvania and New Jersey. The university will apply for a federal grant for the project, Farberow says.

The Med-eMonitor also is being used in a pilot program by the University of Texas Health Science Center in Austin to track medication compliance of 10, and soon 20, schizophrenic outpatients. "We've found that with schizophrenic patients, alarms and signals help them to take their medicines, and that means they're less likely to have a relapse or be hospitalized," says Dr. Dawn Velligan, a professor in the Department of Psychiatry at the University of Texas Health Science Center and co-director of its division of schizophrenia.

In addition to helping improve the medication compliance of patients with chronic or mental illnesses, as well as those in clinical drug trials, Farberow says electronic drug-monitoring devices also can assist elderly patients who tend to forget to take their prescribed medications. The devices also can remove the embarrassment people feel when they forget or need to be reminded to take their medicine, especially when it comes to clinical trials. Says Farberow, "People are less likely to lie to a machine than a human," about compliance to their medication regime.