Electronic Pillbox Helps Seniors Stick to Drug RegimensPosted: Updated:
The study, which was funded by the National Institute on Aging, was presented recently at the American Geriatric Society meeting in Washington, D.C., by co-authors Vesta Brue, founder and chairman of Lifetechniques Inc., of San Antonio, and P. Ryder, of the University of Maryland School of Pharmacy and Pharmaceutical Health Services Research division. Lifetechniques is the manufacturer of the particular electronic pillbox that was the focus of the research.
The interactive pillbox was given to a group of patients between the ages of 65 and 84 who were each following a prescription regimen of a least four medications.
All the patients were self-sufficient with respect to their ability to take their own medications and to move about freely. About one-third of the patients were men. About 38 percent were white, 40 percent were black, and 22 percent were Hispanic.
After three weeks to monitor natural pill-taking patterns, patients were tracked for three more weeks using "MedSignals" -- an electronic pillbox that is already commercially available.
The pillbox holds up to a month's supply of medications, with separate compartments for up to four drugs. As programmed, the box beeps at pill-taking times, indicates the appropriate compartment, and displays the number of pills to take on a screen. As well, when the compartment lid is lifted a programmed audio message announces the number of pills to take, along with specific information about how to ingest the particular medication.
All the boxes were rigged to record, time-stamp and transmit via phone lines all lid openings, which the researchers equated with the taking of an actual medication. The researchers noted that the pillbox comes with such a phone-monitoring system, for patients and their caregivers to use as desired.
The researchers found that electronic pillboxes boosted drug adherence. With the boxes, patients prescribed more than a single dose per day of any particular drug took one pill more per day on average, the authors found. As well, the number of days when patients accidentally skipped their drug regimen altogether dropped to just 6 percent when using an electronic pillbox -- from 12 percent without the box.
In addition, the proportion of doses taken within 15 percent of the time they should be taken went up with the electronic pillbox.
Dr. David Flockhart, director of the division of clinical pharmacology at Indiana University's School of Medicine in Indianapolis, said the notion of an electronic pillbox draws critical attention to a major public health concern.
"Compliance with medications is a huge problem in general, and in particular among the elderly," he observed. "And it is even more problematic among those who take a lot of medication, which is a lot of people, given that the majority of seniors who take medications take more than five prescriptions a day. So the value of something like this is potentially very large."
"However," he added, "the question always come up as to whether these kinds of benefits seen in a clinical trial would really translate to the real world. Because the patients in a study like this know that they're being monitored, so they might be remembering to do something when the box beeps that they might not actually remember in real life. So I would encourage the investigators to follow up this finding with a strictly observational study, rather than a clinical trial, to see how this will work in a natural setting."
To take control of their prescription medication regimen, the U.S. Food and Drug Administration recommends that senior citizens use a calendar or a pillbox to help adhere to drug routines. They point out that pillboxes with multiple compartments are particularly helpful for older patients dealing with complex multi-pill regimens, as well as for those who have difficulty opening safety sealed drug containers.
The FDA also encourages seniors to undergo a yearly "Medicine Check-Up," as an opportunity to both toss out expired medicines and to discuss possible drug side effects and interactions with a pharmacist and/or doctor.
On that score, a second study also presented at the meeting by Yale University School of Medicine researchers indicated that more than 90 percent of senior citizens taking five or more medications experience one or more "mildly bothersome" side effects. And one-third attributed such mood change, insomnia, impaired balance, fatigue, and/or dizziness problems to one of their medications.
For more advice on safe prescription medication use for senior citizens, visit the U.S. Food and Drug Administration.
SOURCES: David Flockhart, M.D., Ph.D., director, division of clinical pharmacology, Indiana University School of Medicine, Indianapolis; April 30-May 4, 2008, American Geriatric Society meeting, Washington, D.C.
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