Tag Archives: Medical technology

What Color is My Pill Doc? Using Technology to Improve Medication Compliance

It is clear that patient compliance with prescribed medications is critical to success in the treatment of any chronic disease process.  In addition, patient engagement and co-management of their disease has been proven to improve outcomes.  This past month a new study from the Annals of Internal Medicine suggests that any changes in the appearance of a medication may result in a decrease in compliance–when a pill looks differently patients often simply stop taking them as prescribed.  In this study, a change in pill color was associated with a 34% increase in medication discontinuation and a change in pill shape was associated with a 66% increase in medication discontinuation.  In cardiovascular patients in particular, the sudden discontinuation of medications can result in increased hospitalizations for chest pain, congestive heart failure and other more serious acute cardiovascular events. For other disease processes such as diabetes, medication non compliance can be devastating and life threatening as well.

The Challenges of Managing Poly-pharmacy

In general, today’s patients are taking more medications for a multitude of ailments and even for the most astute patients keeping track of doses and regimens can be a challenge.  Add in changes in color and appearance of chronic medications and the task can often be overwhelming for elderly patients with cognitive decline.  According to a study published in the Journal of the American Medical Association in 2008, nearly 81% of adults aged 57-85 took at least one pill and 29% took 5 or more drugs.  In addition, nearly 50% took concomitant over the counter drugs and/or supplements as well.  Side effects, drug-drug interactions and other concerns have led many physicians to attempt to streamline medication use and avoid the dreaded “poly-pharmacy” patient.  However, this serious public health problem is further complicated by patient non-compliance issues.  Many regulators argue for more FDA intervention as well as requiring generic drug makers to conform to non generic shapes and colors when manufacturing generic substitutes.  However, I believe that this data argues for a more comprehensive, patient centered approach to increasing medication compliance.

Leveraging Technology in Seniors

Technology today is ubiquitous in nearly all age groups. According to a Pew Research poll, most seniors utilize the internet and a large majority of these users interact via tablets, computer or other mobile devices.  As we age, we tend to live with more chronic illnesses and seem to require more daily medications.  Given the fact that now seniors are actively engaged on the internet, it makes sense for medical professionals to use these powerful tools to assist patients with management of their disease.  Many EMR systems already incorporate “patient portals” which allow for direct patient access to certain parts of their medical record such as test results, appointments, etc.  In addition, there are websites such as Pill Identifier that allow patients and physicians to search a large database of drug images in order to more accurately identify a medication–this is particularly useful when a patient approaches a visit in an Emergency Room or has a consultation with a new physician.

Based on the newly released study in Annals, it is clear that pill identification (and consistency of appearance) is critical in maintaining patient compliance with chronic medical regimens. Regulatory agencies are slow to act–forcing private generic drug makers to keep the size, shape and color of the generic consistent with the brand name is not realistic.  I believe that we can use tablet technology to quickly address this issue.  What if we create an application (downloadable to mobile phone, tablet and laptop) that is able to quickly identify all shapes colors and sizes of a particular drug? Currently there is a pill identifier app on the market but it requires the user to enter color shape and size in order to identify the correct medication–are there better apps yet to come? Ease of use and accuracy will be key components to any new medical applications aimed at older adults.

What Are Potential Solutions?  What Can WE Do Now?

As healthcare providers, we must do a better job encouraging the use of technology to help identify drugs and promote compliance.  The Annals study is a stark reminder that even though we may prescribe the best, most evidence based regimen to treat disease, it takes very little for our patients to become sidetracked–something as simple as a change in shape or color may result in the discontinuation of an effective, potentially life-saving medical treatment.  As physicians, we sometimes forget the “simple things” such as the importance of consistency and routine for our patients.  The culture of healthcare in the US no longer allows for the extended office visit and frequent follow up in order to ensure that patients are compliant with their treatment plans–we are asked to see more patients, in less time and the documentation requirements have become paramount in practice.  We must look for alternative ways to assist our patients with managing their disease while at home–I believe technology is the answer.  We must provide education and resources for our patients and assist them in the identification and use of medical applications.  With technology, we may be able to extend our reach–and support for our patients–well beyond the walls of our office.

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“Thinking” About How We Lead: How We Make Better Decisions and Produce Better Outcomes

As physicians we are trained to assimilate data, analyze and interpret findings, and make the correct decision–every single time.  Often these tasks must be performed very quickly and in emergency settings.  For those who perform invasive procedures, decisions are often made “on the fly” and can have significant consequences.  In addition to our clinical duties, physicians are now thrust into executive roles as well.  Managing practices, budgets, government mandates and regulations have now become part of everyday clinical life for many practitioners.  The concept of the physician executive is now commonplace—and for many doctors and practices– a key to survival in an unstable and volatile healthcare market.  Improving skills in both decision making and communication can be critical to success in the new world of healthcare.  Learning to LEAD is critical to providing outstanding care for our patients every single day.

This week in the Wall Street Journal, author Andrew Blackman explores the inner workings of a business executive’s brain–exactly how the brain functions when making effective decisions in the world of business.  Researchers evaluated how executives make decisions under a variety of circumstances–they localized the biologic processes that occur in the brain via advanced neurologic imaging techniques.  From a biological standpoint, this research provides great insight into how successful decision makers formulate plans and solve problems.  In addition, the research provides insight into how leaders can make more effective decisions when under duress.  Using complex imaging to map the electrical connections in the brain when decisions are made, researchers are able to better quantify–biologically–what makes some leaders better than others.

By shedding light on how our brain functions when making good decisions, we may be able to one day “train” our brains to utilize particular regions during specific tasks.  For now, much of what Mr Blackman reports concerning optimal conditions for making decisions is applicable to physicians and other leaders in medicine in one way or another.

According to the Wall Street Journal, there are several things to consider when making important decisions:

(1)  Deadlines and Time Pressures may Limit Creativity and Innovation

In medicine, every day is a deadline.  Schedules of patients packed into the office or procedure list remain a reality.  Making decisions under pressure is a big part of what physicians do on a daily basis.  However, the recent neuroimaging research indicates that often the deadline pressure may stifle creativity and lead to poor decisions.  Stress induces more activity from the area of the brain associated with “task completion” and less activity in the areas responsible for new and creative idea generation.  According to Harvard researchers, one way to potentially combat this change in thought centers during times of stress may be to train workers and leaders to become more self aware and use “mini meditation” to help the mind wonder.  Although in medicine, we are trained to REACT to acute situations, it may be that while we REACT, we can also work to explore other creative centers of our brains in the process.  By combining both quick REACTION and creative thought, we may not only be able to stabilize a critically ill patient but also provide a unique treatment plan going forward.

(2)  Worry and Uncertainty can lead to bad Predictions and poor decisions

I have been accused of being “Chicken Little” on more than one occasion.   Uncertainty is something that is commonplace in medicine yet it makes most of us uncomfortable.  As physicians we rely on data to make good decisions.  However, uncertainty remains a significant part of what we do in medicine on a daily basis.  We often deal with limited data and must make a decision based on the best available evidence.  Clinical trials bring us some level of certainty  but our patients are biologic organisms, each with potential differing responses to treatments and disease.  According to researchers, the areas in the brain that are activated when you are working on problems that are cause you worry are often associated with anxiety and disgust.  Many poor decisions are made due to the “worst case scenario” line of thought.  While worry and uncertainty can never be completely avoided, psychologists argue that the way to avoid poor decisions during these times, is to learn to accept uncertainty and control the things that you can control.  No decision is ever final–even in medicine there are opportunities to act, refocus and change directions if necessary.

(3)  Good Decision Makers may look past the Facts and Incorporate “Gut Instinct”

Many decisions in medicine are made by considering the best available data and incorporating clinical judgement and instinct in order to make a determination as to the best course of action.  Interestingly, when MRI scans were performed on the brains of very successful business executives who were involved in making difficult decisions, the areas of the brain responsible for emotion and social thinking began to light up more than the purely analytical areas.  Researchers concluded that those leaders who relied not just on facts but on gut instinct and emotion tended to be more successful.  Social thinking–in simple terms–is the ability to look at a problem from numerous angles.  Seeing the potential impact of a potential decision from multiple points of view can provide invaluable insight and may lead to better decisions in the long run.  In medicine, involving other team members–nurses, technicians, and support personnel–in the care and formulation of the patient’s treatment plan may actually help a physician leader to make better decisions.

(4) Effective Leaders must stay positive and Inspire Teams

When leaders begin to inspire teams of people and lead with passion, certain other areas are activated in the brain–particularly those areas associated with positive emotions and social thinking.  Along with involving other team members in the care of the patient, it is essential for an effective leader and decision maker to incorporate “praise, encouragement and rewards” when motivating teams to perform at a high level.  Creating an emotional bond among members of a medical team can be as simple as asking for input from all involved parties and recognizing outstanding contributions to patient care.

The Bottom Line…

Business executives are adept at making determinations that affect millions (if not billions) of dollars and these decisions can move markets.  In medicine, we must make decisions every single day. While some decisions may be trivial, others may permanently impact the lives of our patients and their families.  Moreover, from a business standpoint, the management of a medical practice in today’s market requires impassioned leadership and great skill in order to remain viable. The work that is done with neurologic mapping in decision making may have provide us with guidance in the future as we develop new leaders.  It may be that through practice and coaching, we will one day be able to activate specific areas of the brain when we are working to make tough decisions.  The strategies and skills that we are able to glean from these types of research activity will allow us to be more effective physicians, leaders and executives in the years to come.

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