Importance of Proper Medication Adherence

Whether taking one medication or many, adherence is always important.

A review study found that between 28% and 52% of people taking medication for depression did not always take the medication as prescribed. The 28% is actually how many individuals stop taking medication as prescribed within the first month! Similar non-adherence rates held for bipolar disorder, anxiety disorders, schizophrenia, and most other chronic illnesses. Because many psychoactive drugs slowly build up in your system, abruptly starting or stopping medication use can be dangerous. Failing to take medicine as prescribed may lead to relapse, health complications, sudden changes in mental health status, and even death.

Increasing medication adherence can also reduce health care costs. Individuals who do not take medications as prescribed contribute to 33% to 69% of all medication-related hospital admissions, according to a 2005 article (PDF) from the New England Journal of Medicine. As a result, poor medication adherence adds approximately $100 billion to U.S. health care costs each year. Thus, it is essential to increase medication adherence and ensure that patients who choose to start or stop medications do so under appropriate medical supervision.

Common Barriers to Medication Use

It is important to stress that failure to take medications as prescribed is not always the patient’s fault. There are many common barriers that prevent effective medication use, including:

• Length of time to start seeing results. Because many psychotropic medications take time to build up in a person’s system, it may take several weeks before the individual begins to feel better. Frustration with this delay or poor communication with health care providers causes many patients to stop taking medications when they do not see fast results.

• Side effects. Many common psychological drugs — especially antidepressant medications — cause unpleasant side effects. Loss of appetite, weight gain, sexual side effects, nausea, and sleep changes cause many people to simply stop taking medication so that they can feel better again.

• Poor communication with prescribing physician. A common cause of poor medication adherence is a misunderstanding about how a drug should be taken. How many times per day? With food or on an empty stomach? Miscommunication about these factors can cause medications to work improperly, preventing symptom relief.

• Financial problems. Certain psychoactive medications can be costly, and some patients may simply not be able to afford to take them as prescribed. Without telling their physician, patients sometimes cut pills in half or vary the frequency of medication use to cut costs.

• Logistics, forgetfulness, or lack of motivation. A number of individual variables also contribute to poor medication adherence. Perhaps a person simply forgets to take her pill bottle to work, or skips lunch and doesn’t want to take her medication on an empty stomach.

Strategies to Promote Medication Adherence and Better Mental Health

One of the common themes I hear when talking to clients who do not properly take their medications is that they simply didn’t realize they weren’t taking the drugs appropriately or that they found something about the prescription guidelines confusing. It’s clear that communication between prescribers and patients needs to be stronger before medication adherence will improve. Use of cell phone messaging platforms such as RxApps can facilitate communication and boost medication adherence. Consider the following potential interventions:

• A prescribing physician could work with the patient to set up a medication schedule, using RxApps to send twice-daily questions, asking if the person took his anti-depressant medications. The physician would receive real-time feedback about missed doses or total end to medication use.

• A client beginning use of anti-anxiety medication might receive a message each evening, asking about common side effects. Care providers could then review the data, noting whether side effects might be a barrier to effective medication use.

• RxApps could be used to track client symptoms (e.g., depressed mood, poor appetite, anxiety) every day. Although the person may not immediately feel better, noticing a slow upward trend in mood could motivate her to keep taking the medication until it takes full effect.

With the ubiquity of technology, it simply doesn’t make sense to prescribe a medication and wait until the person’s next visit to see if it is working properly or being taken as prescribed. Using customizable technologies allows care providers to identify common barriers to medication use and address them in real-time, improving patient health and reducing health care costs.

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It is with great pleasure that we are ready to announce the official soft-launch of our service to help those receiving care for a chronic illness. The initial focus is on mental health, and we have so far created modules for the following conditions:

• Depression
• Congestive Heart Failure
• General Anxiety
• Bipolar I
• Bipolar II
• PTSD
• General Mood Disorder
• Wellness
• Other (whatever you want it to be!)

Please let us know if there are any other conditions you would like to see added to the list. Please also share a few items you would want to track for this condition. We will add these new conditions as quickly as possible, but as we deem appropriate.

A big thanks goes out to everyone that has supported us over the past year and a half. If you have any questions or feedback, please send an email to support@rxapps.com. If you really want to, you can also send one directly to me: jmoore1@rxapps.com

We look forward to hearing any success stories you may have! Remember: it’s all about getting better together.

Have a great day,

John Moore
CEO and Founder

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PTSD Prevalence among US population according to the National Institutes for Mental Health.

With thousands of veterans returning from service in Iraq and Afghanistan, public concern and awareness of post-traumatic stress disorder (PTSD) is on the rise. But war veterans are not the only individuals at risk for this disorder; according to the U.S. National Comorbidity Survey, 6.8% of Americans will experience PTSD at some point in their lives. A variety of traumatic events, including car accidents, rape, physical assault, or being threatened with a weapon, may trigger symptoms of PTSD.

Need for Increased PTSD Treatment Efficacy

Despite public concern about the physical and mental health problems associated with PTSD, many affected individuals don’t get the help they need. A recent study by Edna Foa, an expert in the treatment of PTSD from the University of Pennsylvania, found that a majority of people with PTSD do not receive treatments that have been scientifically shown to be effective. As a result, those with PTSD may not experience symptom improvement and may drop out of treatment because they are not seeing results. Improving treatment efficacy and reducing drop-out rates is key to helping those suffering from this debilitating condition.

Several forms of cognitive-behavioral therapy (CBT) have been shown to be helpful in treating symptoms of PTSD. There are several key components to these treatments: self-monitoring of thoughts and behaviors, completion of relaxation exercises, and confronting aspects of the feared situation. To be most effective, clients should practice these techniques every day, in addition to a weekly therapy session with a trained psychotherapist. One of the reasons that individuals with PTSD fail to make treatment progress is that they forget to do the exercises or find them too difficult.

Use of New Technology to Improve Psychotherapy Outcomes

Using technologies such as ecological momentary assessment can help individuals with PTSD overcome these common treatment barriers. By providing real-time feedback about symptom severity and treatment compliance, those with PTSD can get prompt interventions that may improve therapy progress.

For example, consider a client I’ll call Jake. Following his military service, Jake has had recurring nightmares about an incident in which an IED exploded nearby and killed his friend Paul. Now that he’s back home, any situation that reminds him of that event — a hot afternoon with blazing sunlight, seeing slight movements on the side of the road, hanging out with close military friends — triggers uncontrollable anxiety. Jake has begun avoiding his friends and has stopped driving himself anywhere. Over the past three months, he has started drinking to dull his anxiety.

During the course of therapy, I helped Jake learn to do relaxation exercises when he entered situations that trigger his anxiety. I also encouraged him to monitor his symptoms, to better understand what environmental cues might affect his experience of PTSD and how they might trigger his need to drink. Although these techniques are designed to help Jake improve his symptoms, it’s a lot for him to keep in mind each day. Using modern technology to keep track of symptoms and use of relaxation strategies provides detailed, real-time data about Jake’s progress. This is not only informative for me as a treatment provider, but also gives Jake a better understanding of his own mental health.

With the reminder of a product such as RxApps, Jake might keep better track of his symptoms, including when he feels the urge to start drinking. A 2012 study (PDF here) performed by the Veterans Affairs Healthcare Network in New York found that this type of monitoring strategy reduced PTSD symptoms and helped to curb harmful drinking over a one-month period. By prompting the individual with PTSD for real-time information, these strategies make the client an active participant in his or her own therapy, which often improves treatment efficacy and reduces drop-out rates. The techniques also provide necessary information to treatment professionals, who can tailor the therapy to meet each individual’s unique needs.

Some more information on PTSD. Infographic originally posted here: https://www.militarymentalhealth.org/militaryptsd/

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It takes a very confused and disturbed mind to target a function that caters to families and athletes from around the world. This race has been a longstanding tradition of happiness and revelry for me and my friends, and the second worst outcome of this is going to be the anxiety and fear that each participant (runner or observer) will feel over the coming years. We have faith in humanity and the power of our city to rise above this, but it will obviously take time to heal.

Our thoughts and prayers are going out to the victims and their families.

Please see below for additional resources:

Reddit compilation of news, resources, other updates

Disaster Distress Resources

Blood Donation Sites in Boston area (please wait until the week of the 22nd to donate)

Boston Police Department on Twitter

George Takei, always a favorite on Facebook, expresses his faith in the good people of our country.

CNBC confirms that marathoners continued to run to MGH to give blood.

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Self-Monitoring and Treatment Adherence

As a psychologist, I often see clients suffering from major depression who feel frustrated by their treatment progress. Many of them are on antidepressant medications but only meet with their prescribing physicians once every three months. Between appointments, depressed individuals often struggle to self-monitor their behavior, and important clinical information may slip through the cracks.

For example, I recently met with a client I’ll call Lisa, who has been suffering from a major depressive episode for nearly five months. Recently, Lisa has been feeling too depressed to get out of bed; she has called in sick to work several times and hasn’t been meeting up with friends. On two occasions, Lisa felt so depressed and tired that she forgot to take her antidepressant medication. Although she noticed that her symptom severity was increasing, she felt so lethargic and apathetic that she didn’t bother to tell anyone. Meanwhile, Lisa’s primary care providers (myself and her physician) were unaware of these developments in her treatment adherence and mental health status.

How Might Novel Technologies Help Depressed Individuals Receive Better Care?

Advances in mobile technology have spurred researchers to create new techniques that facilitate stronger health communication. Identifying changes in relevant symptoms and behaviors in real time gives care providers more information about a patient’s status. A recent meta-analysis conducted by Marije aan het Rot and her colleagues at the University of Groningen, Netherlands, investigated the impact of real-time symptom monitoring on well-being in depressed individuals. The study found that monitoring individuals’ emotions in real time provided a wealth of information about potential treatment responsiveness and effectiveness of care.

Mobile applications such as RxApps could be employed to assist clients like Lisa who are struggling with depression. Giving Lisa a platform to report her symptoms in real time, identify days when she missed her medication, and track whether she is engaging in self-care behaviors provides valuable information to care providers and to Lisa herself. The result? A more collaborative relationship that allows the patient and mental health professionals to work together to create an effective treatment and restore mental well-being.

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Dr. Hendrick is the psychiatrist/therapist/counselor for the hospital where the show takes place. He’s popped up a few times, always to irritate JD (main character), who often forgets how important mental health is to overall health. It doesn’t help that Dave Foley’s character often makes his points in a rather smug fashion.

What he says here caught my attention because it is an example of a sitcom nailing one of our key points in 14 seconds. Leave it to television to convey what we all know, but often refuse to face.

Mental illness is difficult to deal with, both as a patient and as a family member of one. We put so much faith in medications, simple fixes, because we have been raised to believe that illness can be treated with pills. Mental wellness, which influences all other components of our wellbeing, takes a bit more effort. I can’t think of a single person I know that is on meds for depression, bipolar, borderline, etc, for whom medication alone helped them.

Don’t get me wrong. I am a big believer in properly using medication to help those that need it. But thinking we understand the mind well enough to prescribe medications like we do for diabetes, colds, heart failure, and everything else is naive. So please, remember to take the time to treat emotional and mental wellbeing, if you are a doctor, nurse, friend, parent or patient. We, as a species, are still learning.

We’re just doing our part to keep society honest and moving forward.

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With more than one billion overweight adults and 300 million obese individuals worldwide, the prevalence of obesity is at an alarming rate. This epidemic is associated with many physical health conditions, including increased instances of cardiovascular disease, type 2 diabetes, and many specific forms or cancer. There is also ample evidence to support a direct link between obesity and mood disorders and depression. Obesity is one of the leading causes of depression, which affects nearly 121 million people throughout the world, according to the World Health Organization. Yet, there remains little information available to the public about the correlation between obesity and a heightened risk of depression.

Obesity in the Media

The media does an excellent job of pointing out the physical health risks associated with obesity. It’s nearly impossible to make it through a news day without some mention of these health risks. However, little mention has been made in the media regarding the mental health aspects of obesity, despite the fact that research continues to show a distinct correlation between the two.

Case in point: a link between a high-fat diet and symptoms of depression was found in a recent neuro-scientific study conducted in association with scientists from Montreal’s University Hospital Research Centre and Faculty of Medicine. The study findings, published in the International Journal of Obesity discovered that high-fat diets serve to change the brain chemistry in order to create “depression biology.”

Study author Dr. Stephanie Fulton describes the similarities of effects of a high-fat foods with certain drugs as this: “In addition to causing obesity, rich foods can actually cause chemical reactions in the brain in a similar way to illicit drugs, ultimately leading to depression as the ‘come-downs’ take their toll.”

Depression and Obesity

Depression + Obesity is a toxic cycle that starts as early as childhood. Photo from Telegraph.co.uk

Many people see obesity as the cause of depression. However, researchers at the Washington University School of Medicine in St. Louis and the University of Pittsburgh suggests that depression in childhood can lead to risks of heart problems later in life, and one of the contributing factors is that children who were depressed are more likely to become obese teens. They’re also more likely to smoke cigarettes and less likely to exercise than teens who were not depressed as children.

The “vicious cycle” kicks in when depressed children begin eating as a coping mechanism for depression. This leads to obesity, which only fuels the depression and isolation. Once again, this turns to their coping mechanism of choice – often rich fatty foods that provide momentary comfort.

Dealing with Depression and Obesity

As new evidence builds that obesity and depression can be so interdependant, it’s important for people suffering from obesity to take active steps to break the cycle and change their state of being. Moreover, it’s also essential for physicians to recognize this and work with depressed individuals closely to thwart off a dive into obesity. These are the steps that patients should take — and physicians should recommend and monitor — in order to end the cycle for good.

1. Eat well. Get rid of fatty foods that provide temporary solace and replace them with foods that provide fuel for the rest of the steps in the process.
2. Exercise more. Endorphins are a side effect of exercise that provide a “feel good” sensation in the short-term. The long-term impact of exercise is a better body image and more stable frame of mind.
3. Meditate. There is plenty of evidence to support that meditating regularly can help balance emotions and stabilize mood, even if only 10 minutes a day.
4. Collaborate with medical professionals. Depression is a medical condition. It needs medical treatment, communication, and tracking. More importantly, patients suffering from depression and obesity need to develop a better understanding of their individual condition – and to self monitor it. RxApps is one tool that patients and their doctors can use to better treat the condition together.

It doesn’t really matter which came first. Was it depression or obesity? What matters now is that people suffering with depression and obesity get the help they need in order to return to a happier, healthier state of being. Exercise, meditation, and dietary changes can only accomplish so much. They can’t address the depression on their own. Without adequate patient/doctor collaboration, lasting healing and recovery is unlikely.

Related:

Barriers to exercise among people with severe mental illnesses.

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Eric Topol on Rock Center

I’ve seen Dr. Topol speak before, and he does tend to rehash the same examples (ie AliveCor ECG), but he does often make some great points about the future of medicine and the role that digital technologies will play.

A few highlights from this video:

• Dr. Topol is prescribing applications for patients to manage their conditions
• He uses mobile digital devices in the office to reduce the costs of care
• The patient use case is particularly telling. He comments that the integration of these devices into his check up makes the office visit much more pleasant and convenient.
• Topol believes these technologies make the interactions more intimate, allowing sharing and discussion of results in real time. No need to wait for a lab and then discussing over the phone or coming in for another visit.
• Finally, he believes many appointments could be done remotely with these devices if patients are trained in their use. This would dramatically reduce the overburden we currently see of medical facilities and save everyone time by engaging in more proactive care. Huzzah!

If you notice, all of the devices and applications discussed are meant to replace/supplement traditional brick and mortar services, especially those that require a technician. Of equal importance in our estimation are monitoring those aspects of clinical care that aren’t related to capturing biometric data, ie the patient experience of illness and treatment. Hence our focus on monitoring lifestyle changes and their influence on symptoms and quality of life, specifically related to mental illness and its impact on overall health.

For some more Eric Topol goodness, check out his TEDMED talk from 2009 (and see how much things have changed over the past few years), and if you are the literary type, here is also a link to his book on Amazon.

At TEDMED 2009

The Creative Destruction of Medicine on Amazon.

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Despite the periodic detractors, the area of mobile health is clearly a very promising opportunity to improve the health of our nation. We are constantly connected to the rest of the world now, which can help extend the healthy influence of care providers. Furthermore, we are more likely to be honest with these electronic interfaces than with a live person, which can provide insights into our health that would have otherwise been missed until too late.

In light of recent news that Happtique is ready to start certifying applications for their healthcare app market, we thought it was time again to discuss the importance of apps that doctors can legitimately prescribe their patients.

Dr. Who? Even a Time Lord uses a smartphone these days to stay up to date on relevant developments.

Fast Facts:

• 87% of Americans own a cellular device (estimates go up to 92%)
• Approximately 45% of those are now smartphones (up to 54% according to some)
• 93% of physicians believe mobile health apps can improve a patient’s health outcome (see infographic from eCW below)
• 76% of cell phone users send and receive text messages regularly (other estimates go up to 85%)
• 19% of smartphone users already use mobile health apps
• There are well over 40,000 health apps available for download

That last bullet is the kicker, and shows why there is a need for some type of certification process to weed out the bogus applications from those that can actually have an impact on health. The Happtique certification requirements are pretty straightforward, essentially requiring that all claims made by the app manufacturer be true in regards to performance and clinical efficacy, and meet the need for privacy and security when the application deals with PHI.

This is obviously important, but to us it doesn’t justify the proposed fee of $2000-$3000 for review. It would make a lot more sense to simply hire a software testing agency to validate claims of performance and then file with the FDA for clearance around benefit claims. The one nice thing about going through Happtique is that it may be a faster process than the FDA and it provides an additional sales channel for companies looking for an expedited way in the door with care organizations. It would have been far more interesting to see the Happtique panel of experts demand a little more from any apps meant to be used in the clinical setting (prior use in clinical setting, a categorization of different types of apps, something).

A critical point of contention for us, and something that has always been a concern with the Happtique model, is that only focusing on smartphone applications is a bit of a snub to the other ~50% of cell phone users. Granted, our company name is a variation of our initial PrescribableApps brand, but we always took the broad view of apps, which include web-based applications like Facebook, YouTube, and Twitter.

Instead of focusing on an application that works on one platform, we developed a web application optimized for inclusion, which means it can work on any mobile device via text message or mobile web, as well as any of the major browsers (all the way back to IE7). This allows us to reach the entire 87% of the population with a mobile device. It is a significant error of omission for Happtique to serve the medical establishment and not take into account that many of the patients most in need of these additional health services may not own a smartphone, and almost certainly are not all on the same platform.

What do you think about their proposed requirements? Happy to hear your thoughts!

More reading:

• MobiHealthNews: Pew: 19 percent of smartphone users have health apps
• NYTimes: Coming Next: Using an App as Prescribed
• KevinMD: Will doctors recommend health apps to patients?
• CNN: Your phone will know you’re sick before you do

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Some of you may have heard already, but apparently the Westboro Baptist Church is planning a trip to Vassar College at the end of the month to protest tolerance. This is the church that spews homophobic hate speech and hides behind religion to justify their bigotry, something I personally cannot stand. In response to their plans – and this makes me incredibly proud to be an alum – a number of students decided to use the church’s right to practice free speech as a means of fundraising for an LGBTQ non-profit called the Trevor Project, whose mission is to prevent suicide among LGBTQ youth. Pretty fitting that we should be supporting this initiative!

Setting the initial goal at something reasonable but significant, they set out to raise $100 for every minute the WBC was planning on being on campus, or $4,500. Once news of this spread, the support from the Vassar community, and all those who oppose what the WBC stands for has been tremendous, and at the time of writing this, just over $70,000 has been raised. This Valentine’s day, please think about the meaning of love, which generally knows very few bounds, and how absurd it is that there is a group devoted to making others feel guilty for how they experience intimacy. How about instead of spending $20+ on chocolates that have no real meaning, you spend that money as a donation to support this very productive counter-protest that supports tolerance for all.

Thanks, and happy Valentine’s Day!

To read more:
http://www.salon.com/2013/02/13/college_uses_a_visit_from_westboro_to_fundraise_for_lgbtq_group/

To donate:
http://www.crowdrise.com/vcfeb28

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