The Context-Aware Pill Bottle and Medication Monitor Video – Great Without Glitz
There is nothing technologically unique about the Context-Aware Pill Bottle and Medication Monitor (an accurate but not euphonious and decidedly not catchy name) from the University of Calgary, and there is certainly nothing slick in the production values of the video about that appliance. Yet, it is indeed a must-see presentation.
The first portion of the video, which explains the intent, positive effects, and workings of the mechanism, will appear familiar to anyone who has seen promotions for medication dispensers/reminders, but the portion that follows the “Critique” heading enters uncharted territory to those who don’t routinely attend research meetings. It is during this critique, you see, that the same individual who presented all the benefits of the device discusses possible flaws in its design. The informative critique is not only enlightening but also heartening.
Of course, this is a video version of a research paper. One shouldn’t expect an ad agency to suggest the same sort of balanced presentation to a client trying to sell a product.
Still, one can dream.
The Context-Aware Pill Bottle and Medication Monitor1, May. Video and two page paper, duration 3:58. Also as Report 2004-752-17, May.))
Abstract: The video illustrates and critiques a context-aware pill bottle/stand that reminds the elderly when it is time to take their medication. A medication monitor situated in a caregiver’s home displays awareness information about the elderly user’s medication compliance.
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Agarawala, A., Greenberg, S. and Ho, G. (2004). The Context-Aware Pill Bottle and Medication Monitor. In Video Proceedings / Proceedings Supplement of the UBICOMP 2004 Conference. ((September 7-10, Nottingham, England↩
An article in the Health Journal portion of the 20 April 2010 Wall Street Journal, The Birth-Control Riddle by Melinda Beck, offers these impressive statistics regarding unintended pregnancies:
Almost half of all pregnancies in the U.S.—some 3.1 million a year—are unintended, according to the most recent government survey, from 2001.1 One out of every two American women aged 15 to 44 has at least one unplanned pregnancy in her lifetime. Among unmarried women in their 20s, seven out of 10 pregnancies are unplanned.
While the causes of the problem may be, as the article’s title indicates, a riddle, its mechanics are not:
Almost half (48%) of unintended pregnancies involve contraceptive failures. In 52% of cases, couples used no birth control at all. Cost is a factor for some of them. Even though most insurers now cover contraceptives, co-pays and deductibles can still present obstacles.
And many young people are in “the fog zone” in which their beliefs about pregnancy don’t match their behaviors, according to a 2009 report by the National Campaign to End Teen and Unplanned Pregnancy. In a survey conducted by the Guttmacher Institute of 1,800 single men and women aged 18 to 29, more than 80% of both sexes said it was important to them to avoid pregnancy right now, yet 43% of those who are sexually active said they used no contraception or used it inconsistently.
The following chart from the CDC (not in the WSJ article) offers confirmation of the premise that most couple incidents of unintended pregnancy were the result of not using any contraceptives.
In 2002, among women who reported that their pregnancy was unintended, the prevalence of contraceptive (any method) use at the time of pregnancy ranged from 38.7% (Hawaii) to 53.3% (Vermont).
During 2000–2002, the prevalence of contraceptive (any method) use at the time of pregnancy among women with an unintended pregnancy decreased in 4 states (Florida, New Mexico, New York, and North Carolina).
Some population experts say the rates of unintended pregnancy would be far lower if more women used IUDs and implants that prevent pregnancy for years at a time. Only about 3% of American women currently do.
“There are terrible misperceptions about these methods— and about all forms of contraception,” says James Trussell, director of the Office of Population Research at Princeton University.
Many traditional forms of contraception have been updated in recent years. Here’s a look at the latest developments: …
A summary of the pros and cons of various contraceptive methodologies, under the headings, The New IUDs, The Implant , Hormone Pills, Patches And Rings,Condoms, Caps And Sponges, Emergency Contraception, Permanent Birth Control, and Vasectomy Variations, completes the piece.
The Problem With Education And Technology As Solutions To Noncompliance
The advancements in effectiveness, safety, and ease of use of contraceptive technology are important and may well trigger incremental improvements in the rate of use of these methods. Nonetheless, the emphasis on improved technology begs the question of why none of the previously available, well publicized contraceptive methods (e.g., birth control pills, abstinence, diaphragms) were used in half of all unintended pregnancies.
And, educating patients beyond the basics (i.e., the instructions for safe and effective treatment implementation and a simple explanation of how the medication, diet, surgical procedure, etc. works) has rarely proved successful in significantly ameliorating noncompliance.
The most problematic aspect of the focus on education and technology, however, is that it distracts from other possible factors, including the cultural, socioeconomic, and psychological issues that may prevent a woman and her partner from using any contraceptive method regardless of their understanding or appreciation of the technology.
Given that unintended pregnancy has been shown to influence a woman’s behavior and experiences during pregnancy and in the post-natal period to the detriment of the health of her infant, this is a noncompliance problem that merits a more inclusive response than appeals for more education and tbetter technology, however worthy those efforts may themselves be.
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The same article goes on to note: “An updated version of those numbers from the 2006 National Survey of Family Growth is expected to be released next month. But population experts don’t anticipate much change; the rate of unplanned pregnancy was the same in 1994, and smaller studies have found that even newer birth control methods haven’t made much of a dent.”↩
Note: PRAMS data is not collected in all states. In 1999, for example, data was collected in 17 states: Alabama, Alaska, Arkansas, Colorado, Florida, Illinois, Louisiana, Maine, New Mexico, New York, North Carolina, Ohio, Oklahoma, South Carolina, Utah, Washington, and West Virginia↩
Development of an effective methodology for managing patient noncompliance remains unlikely as long as the strategies being investigated are limited to those already shown to be ineffective.
Key Point: Noncompliance is not exclusively a medical issue but a personality trait that manifests in many areas of life. Treating patient compliance as though it’s a straightforward, sui generis phenomenon independent of other human behavior all but eliminates the potential for significant advances in the field.
Employing a Copernican perspective to find compliance solutions that work
Do away with the restrictions implicit in the contention that healthcare compliance is unique.
Change the compliance game from clinician vs. patient to clinician & patient vs. problem being treated
Once more unto the breach, dear friends, once more1
Paul Tunnah, founder of pharmaphorum, an online pharma discussion and networking site, invited me to submit an overview of patient noncompliance. The first portion of that paper was published today at Rethinking patient noncompliance (Part 1).
While those who have followed my efforts on AlignMap will find little that is surprising, the article does, I think, offer a coherent, condensed summary of the current, problematic status of treatment adherence. The main points, sans discussion, follow:
The Dysfunctional Concept Of Patient Compliance
1. Patient compliance, as described by its standard definition, is a useful statistical measure but an inadequate and often counterproductive explanatory concept. Key Point: The term patient noncompliance, by definition, is no more than a descriptive label given to a phenomenon and indicates nothing about the cause of that phenomenon.
2. Noncompliance leads to inadequate implementation of treatment recommendations, which itself leads to devastating economic and personal consequences. Key Point: Characterizing the financial, physiological, and social costs of patient noncompliance as catastrophic is neither hyperbole nor hysteria, just fact.
3. Patient noncompliance is, by any measure and from any perspective, pervasive and difficult to detect. Key Point: While patient compliance varies, a reasonable expectation, absent evidence to the contrary, is an average compliance rate of 50%.
4. No practical methodology has been shown to significantly, reliably, and enduringly enhances compliance for a diverse patient population. Key Point: Many methodologies designed to enhance compliance are effective – for some patients some of the time; none of these methodologies are effective for most patients most of the time. Further, no methodologies have been demonstrated to predict which patients will and will not follow treatment recommendations or which patients will respond to which compliance enhancement techniques.
Solutions, AKA Coming Attractions
A new perspective on treatment adherence that offers potential solutions is the focus of Part 2 of Rethinking Patient Noncompliance, which will be published at pharmaphorum next week.
