Electronic Pill Box Proves to Be Good MedicineBy M.L. Baker | Posted 03-25-2005
The device sends this information to a secure Web server, where practitioners monitoring a patient's care can see the information and intervene quickly if the patient stops taking medicine or reports ill-effects. The Web server also updates the device with new alerts, like upcoming doctor visits or changes in dosages.
Dawn Velligan directs the division of schizophrenia-related disorders at the University of Texas Health Science Center and is testing the device in a small clinical trial of schizophrenia patients. She receives consulting fees from Informedix.
One reason why medications for chronic diseases don't work is that patients forget to take them or take them at the wrong time. This is particularly an issue for patients with schizophrenia; less than half take their antipsychotic medications as directed, and those who don't are more than twice as likely to be hospitalized, Velligan said.
Preliminary results from the trial are both striking and statistically significant. Before the study, said Velligan, patients were taking medications as directed only about 50 percent of the time. With Med-eMonitor, adherence rose to 94 percent. Patients could also lead more independent lives. One patient who needed her parents' help to take pills was able to do so on her own using this device.
Velligan said the device also helps clinicians make better decisions about patient care. Patients often don't realize how frequently they forget to take their medicine or are unwilling to tell a doctor they haven't adhered to a treatment program. So when doctors see suffering patients, she said, "they don't know whether to change medication or get them to take their medication."
Bruce Kehr, CEO of Informedix, said he came up with the idea for a smart pill box when his grandmother became ill. "In her 90s, she lived alone but kept getting hospitalized. No one could make a diagnosis. We finally traced it back to her confusing medication," he said. But Kehr's grandmother hated having paid caretakers and grandchildren visit her daily to monitor her care, and that spawned the idea for the Med-eMonitor.
The device is about the size of a videocassette and can be carried in a fanny pack. Multiple drawers each hold about a month's supply of medicine. It alerts the patients when to take medicine, records the date and time when a medicine drawer is opened, and prompts patients to answer questions and complete other tasks.
Med-eMonitor can help rural patients get better care, said Kehr. "In our diabetes program in Billings, Mont., patients 200 miles away are being monitored for medication adherence and glucose levels, and physician are changing medications over the Web because patients can't get into a center."
Disease management companies and centers running clinical trials often ask patients to keep paper diaries to track their symptoms and medication usage. But patients rarely keep records accurately, and getting the information to clinicians is a hassle. The Med-eMonitor poses a solution to these problems, said Kehr. Other companies offer PDAs so that patients can keep electronic diaries, said Kehr, but do not physically help with medication.
"The unique thing about new technologies like InforMedix is that the recording is automatic and patient feedback is immediate," said Donald Gravlin, vice president at Capgemini U.S., adding that electronic patient disease-management was growing strongly.
However, he warned that the technology still faces challenges, including perceived ease of use and the ability of clinicians to make timely interpretations and interventions using data sent by the pill box.
Kehr declined to give a firm price for Med-eMonitor, saying only that a year with Med-eMonitor would cost less than half a day in the hospital. Currently, clinical trial sponsors or disease management companies pay for their patients to use Med-eMonitor, though Kehr said the company has plans to work with health insurance companies about including the device in covered services.