[Note: This graphic is not illustrative of the actual device discussed below.1]
Automating Motivation With Medication Dispensing
The following are excerpts from the patent application for Patient compliance system and method to promote patient compliance:2
In one embodiment, the completed documenting device, memorializing administration of all of the dosage units of the pharmaceutical agent according to the regimen, can be redeemed by the patient to obtain a reward or incentive. The completed documenting device can be redeemed by forwarding to a designated location via mail, electronically via facsimile, email or internet, returned to the doctor, pharmacy, or the location where the prescription is filled or dispensed, and the like. In another embodiment, the reward is provided at the time the prescription is obtained and can be provided to the patient by the caregiver at the completion of the dosage regimen. In another embodiment, the documenting device is not redeemed, but rather a code is provided by the documenting device which is used to obtain the reward.
The reward or incentive is not limited and can include, for example, toys, games, clothes (hats, scarves, t-shirts, etc.), jewelry (e.g., pins, ear rings, pendants, necklaces, bracelets, rings, etc.), candy, books, coupons, gift certificates, or combinations thereof. The type of reward can be chosen for the particular age group of the patient. For example, pediatric patients can choose from a particular set of toys or games, while geriatric patients or caregiver can choose from clothes, jewelry, books, coupons, gift certificates, and the like.
The reward or incentive can be co-marketed or cross-promoted with the latest television series, book series, movie promotions, video games, characters therein, etc. As such, the reward or incentive can change over time to keep up to date with the latest fashion and culture.
A significant number of devices that automatically dispense medication at the appropriate time and alert the patient or care provider and documents that the medication was “administered” (in this context, “administered” almost always means the medication was removed from the container, “whether or not the pharmaceutical was successfully ingested, inhaled, etc. by the patient”) are on the market. In some cases, the failure to remove a dose from the machine within a given time causes a notification to be sent to a caregiver (e.g., a concerned family member), prescribing physician, pharmacists, or another healthcare professional or organization.
In most cases, no specific incentive for compliance is given. If these devices provide motivation for compliance, it is typically a negative reinforcement (e.g., the implied threat that a family member or a clinician will be notified of noncompliance or the persistence of a noxious reminder, such as a recurrent auditory signal, until the medication is administered3 ). The device described in this patent application does directly address incentives, which have been shown in other situations to be effective compliance enhancements.4
I harbor doubts about the practicality and effectiveness of the specific incentive scheme suggested. Deferred rewards (e.g., coupons or codes to be redeemed at a later date) are less effective, especially for children, than immediately available reinforcements. And, one wonders who will purchase the “toys, games, clothes (hats, scarves, t-shirts, etc.), jewelry (e.g., pins, ear rings, pendants, necklaces, bracelets, rings, etc.), candy, books” used as incentives. Further, it is a behavioral modification 101 principle that reinforcements must be selected for their appeal to a given subject and must be varied over time to sustain that appeal.
Consequently, I laud the notion of automating incentives but suspect the reward program in the application, based on a oversimplified concept of behavioral modification, would be far more effective if a more sophisticated, research-based reinforcement system were used.
The Slot Machine Illustration
I happened onto the slot machine graphic while searching for an illustration for this post (I don’t have access to the drawings in the patent application). I decided to use it even though it wasn’t the kind of graphic I had in mind because, it occurred to me, a reward scheme that emulated a slot machine would ameliorate although not completely resolve some of the problems I describe with this device.
- “Buying a chance to win” with compliance would appeal to some, albeit not all, individuals
- Intermittent reinforcement is more effective than continuous reinforcement
- Rewarding incentives only on “winning” doses rather than every dose reduces the number of incentives needed and lessens the frequency with which they must be changed
Just a thought.
- For an explanation of the use of the slot machine graphic in this post, see section labeled, "Commentary"↩
- Patent Application #20070039624↩
- For an outstanding example of this latter strategy and the marketing utility of compliance definitions, see 98.6% Medication Compliance↩
- I have not made a thorough survey of all such devices, and it is possible and even likely that devices providing positive enforcement for compliance exist. This is the first that has come to my notice↩