But one thing has changed in most of those patients' lives: They now have smartphones capable of running medication adherence apps. One such app, MediSafe, is used to provide gentle, simple-to-understand reminders by patients of Barbara Zink-Frederick, a geriatric and internal medicine nurse practitioner in New Freedom, Pa., about 30 miles north of Baltimore.
After trying other apps, Zink-Frederick settled on MediSafe, preferring the app's division of a day into morning, lunchtime, afternoon, and nighttime, visually displaying the medications at the appropriate time of day, and alerting patients it's time to take their meds with the sound of a pill bottle shaking, to distinguish the alert from other smartphone alerts.
Zink-Frederick also likes that MediSafe now allows patients to enter the time a pill is taken when that happens to be later than the originally recommended time, and that it reminds busy workers to take their pills with them before heading off to work.
When patients visit with her, the app reports a medication adherence score with drill-down details, and the bulk of the patient's visit can consist of meaningful interactions, including education addressing ways to obtain medications if the patient is low-income, for example.
"We set up a plan," Zink-Frederick says. "I actually help them put their original drugs in, to make sure that they get them right. They try it for a couple weeks, see if the way they're taking it is okay, or if they have problems, then it gives me the ability to adjust, move this medication to this time, maybe that won't make the patient have an upset stomach, or maybe this medication will help them with their appetite for dinner."
The boom in e-prescribing is another way that medication management is bridging gaps in care. As many as one-third of prescriptions written in the past never made it to a pharmacy, says Harry Totonis, president and CEO of Surescripts, the e-prescribing network provider owned in part by Walgreens and CVS. If a doctor instead writes an electronic prescription, now that pharmacy knows the patient needs to come in and pick it up, Totonis says.