Catalyzing Commitment: The Symphony of AI-Powered Medication Adherence

Publication
Article
Pharmacy Practice in Focus: Health SystemsMay 2024
Volume 13
Issue 3

Artificial intelligence–driven reminders empower patients, combating forgetfulness and enhancing treatment adherence for better health outcomes.

Abstract

It is not uncommon to see patients with chronic diseases who are unable to adhere to their prescribed dosage regimens, placing them at an increased risk of health deterioration. The lack of adherence to prescribed medications, primarily resulting from memory lapses, has given rise to significant concerns regarding the impact of patient adherence on the efficacy of the treatment. Many health care organizations use artificial intelligence (AI)–driven alerts and reminders to help patients adhere to prescriptions. These reminders use AI to offer targeted and timely alerts regarding recommended drug intake and ensure that patients follow their treatment regimens. This brief review explores the crucial role that AI-integrated reminders play in assisting patients in adhering to their medication regimen. The review examines the utility of these advanced tools in providing immersive and interactive interfaces while also serving as an incentive to encourage and improve patient adherence to prescribed medications. There has been an ongoing focus in health care on advancing AI technologies to elevate health care reminders. These reminders not only serve as prompts but also provide a range of additional attributes. Further research is still necessary to evaluate the efficacy of these AI-integrated tools in enhancing medication adherence among patients.

Introduction

Woman using AI on her phone -- Image credit: THANANIT | stock.adobe.com

Image credit: THANANIT | stock.adobe.com

Medication adherence is the degree to which an individual’s behavior toward drugs is aligned with established guidance and recommendations from their health care professionals and is essential to clinical outcomes.1 Approximately 50% of patients with chronic illnesses do not adhere to their prescribed medication regimen, with forgetfulness identified as a significant barrier to medication adherence.2-5 Moreover, patients who are unable to adhere to their prescribed medication regimen are at an elevated risk of experiencing health complications, increased hospitalization rates, and even mortality.3 According to the World Health Organization, interventions to enhance medication adherence could significantly impact population health more than any specific therapeutic intervention.5,6

Patient reminders play a crucial role in supporting individuals in enhancing their overall health and well-being by reminding them to follow through with their medication schedule or schedule health care appointments and examinations.6 There are various reminder systems used in health care, including interactive voice response systems, phone calls, video calls, instant text messaging, electronic pillboxes, pagers, and personalized blister packs.7,8 Artificial intelligence (AI)–powered tools are increasingly employed in health care for various purposes, notably for assisting patients in adhering to prescription regimens.9

Personalization: Tailored Reminders for Diverse Needs

In the modern era of health care, medication adherence reminders powered by AI have the potential to revolutionize medical outcomes. Essentially, AI can be defined as a program that can learn from data and accomplish tasks without constant human intervention.9 Reminders leverage AI tools to provide patients with personalized and timely alerts concerning recommended drug intake, helping to ensure patients adhere to their designated treatment regimens and therapies.

The AI prescription reminders are developed using advanced AI algorithms designed to cater to specific user requirements. These algorithms consider various parameters, such as prescription schedules, preferences, and potential adverse events (AEs). The AI system employs predictive analytics to assess an individual’s medication routine and provide customized reminders to meet each patient’s needs.10 In a review by Babel et al, the authors discuss a study in which an AI-powered smartphone application, which utilized facial recognition technology and the phone’s camera to confirm patient identity and drug ingestion, was tested to measure adherence in patients following a stroke.9 Results showed 100% adherence in patients who received daily reminders and 50% for the control group, who did not receive daily reminders. Though the reminder system prevented memory lapses from hindering patients’ medication adherence, a small sample size and a short study duration limit the extrapolation of these results.9 Therefore, additional studies are needed to test the efficacy of sophisticated AI reminders on various patient types.

AI-powered reminders can be customized according to patient preferences, including their preferred communication channels and the frequency of reminders. This level of flexibility enables patients to receive notifications in a format that aligns with their lifestyle and daily routine, increasing the likelihood of adherence. Patients can also schedule reminders at specific times of day, adjust the frequency based on dosage requirements, and account for missed doses.9,10

Additionally, one of the key benefits of AI is its ability to effectively monitor drug intake, identify anomalies, and provide patients and health care professionals with real-time feedback. This proactive approach can significantly aid in promptly detecting any non-adherence and facilitating timely interventions, thus minimizing the probability of any complications.6 Several AI-integrated mobile applications offer reminders, each with varying degrees of effectiveness. The rating scale for these apps is typically from 0 to 1, and their performance is measured across different domains. The Figure displays the mean scores of various reminder applications.10,11

Figure: Mean Scores of Advanced AI Reminder Mobile Apps Measured by Domains -- AI, artificial intelligence.

AI, artificial intelligence.

Beyond Buzzing Alarms: Engaging Interfaces for Enhanced Compliance

Study data have shown that instant text messaging can effectively address the issue of drug non-adherence among patients. Messaging interfaces facilitated by chatbots are particularly advantageous, as they are user-friendly and require no prior technical knowledge. This feature makes them an ideal solution for older patients, a demographic that typically consumes a higher volume of pharmaceuticals and may experience more significant challenges with drug adherence.11-14 Digital competency deficits may further exacerbate adherence problems.14

Chatbots also have the potential to provide physicians with personalized reminders, instructions, and patient adherence statistics, thus highlighting any changes or deterioration in the patient’s condition related to medication and disease. While short messaging services (SMS) offer urgent reminders and instructions, they may also be too frequent. In contrast, chatbots can enable advanced feature integration (eg, machine learning modeling), are adaptable, and are notably more cost-effective and user-friendly (eg, simpler for older patients) as they have a comparatively lower learning curve and do not require further installation or configuration.14 Unlike traditional SMS, chatbots can track and report therapy outcomes and patient performance to health care providers.

AI-integrated chatbots are also highly effective in assisting health care systems in underdeveloped and developing countries.14 For example, Roborto, an AI chatbot created by a team of researchers from the University of Trento, Italy, was designed to provide an easily usable interface to attempt to improve medication adherence.14 Patients can add a medication by name or photograph and the bot can set a reminder and prompt the patient to report adherence when it

is time to take the medicine. In addition, the bot can inquire about symptoms and other disease-related information and report to a physician, who can intervene via their own chat window.14 However, limitations can arise depending on how familiar the patient is with smartphones. Younger patients tend naturally to be more adept with smartphone applications than older patients. However, if chatbots are designed with a focus on simplicity and ease of use, short, informative packets or sessions can help familiarize a patient with the functionalities of the chatbots. Though this premise holds potential for improving medication adherence, further research is needed to evaluate the effectiveness of these chatbots.

Gamification: Turning Adherence Into a Rewarding Quest

Employing a motivational approach to promote medication adherence can significantly increase the likelihood of various healthy behaviors, which can enhance the overall quality of life of the patient along with ensuring drug compliance. Conversely, inadequate motivation may result in lower disease comprehension, reduced perception of medical benefits, fear of AEs, and, ultimately, a decreased desire to take the medication, leading to nonadherence to medication.15

A recent study evaluated the effectiveness of playing brief segments of health games on medication adherence. The study found that incentivizing patients with tangible rewards could encourage adherence to medication routines. This approach employed external regulation to motivate individuals who previously lacked motivation. Patients were reminded to stick to their game routine and were informed that they would receive extra incentives at the end of the study if they complied. Conversely, patients were warned that failure to abide by the reminders would result in fewer rewards. These gamified reminders had a positive impact on patients’ self-worth and motivated them to care more about intrinsic rewards, which are their own health outcomes. This further improved motivation and increased the likelihood of adhering to the treatment regimen.16

Implementing gamified features is an increasingly popular practice that has been adopted in various ways, with some approaches specifically designed to cater to the patient population. The most prevalent gamified features identified in the reviewed studies were point-based features such as leaderboards and character levels.17 Mango Health is an example of an AI-driven reminder system that employs a gamified approach to enhance medication adherence. The software incentivizes users with points for adhering to their prescribed medication schedule and adopting other healthy habits. These earned points can be redeemed for rewards including gift cards and charitable donations.18

Predictive Insights: Anticipating Needs Before They Arise

AI-powered reminders and alerts have emerged as promising tools for health care providers to gain valuable insights into the onset of diseases such as cancer, diabetes, and heart disease. The AI programs integrated into these applications and systems can efficiently process large volumes of data from medical imaging tests such as x-rays and other clinical images to detect the underlying pattern of disease onset. These insights can help physicians make informed decisions about treatment options and improve patient outcomes.19

Reminder applications powered by AI can be integrated with various smart devices, including smart bands that can monitor a patient’s heart rate and alert them of an imminent cerebrovascular accident or myocardial infarction.19,20 This instance exemplifies the growing proficiency of machines in deciphering intricate health care data streams, thereby enabling health care practitioners to gain a more comprehensive understanding of their patient’s future health care requirements.20

The First Myocardial Infarction Risk Reduction Program conducted a study that indicates that reminders, such as postcards and phone calls, aimed at mitigating the risk of myocardial infarction for patients at an increased risk do not significantly impact medication adherence.21 The study was conducted in 2001, when technology was less advanced than it is today. Smarter technologies that monitor a patient’s health and send alerts in real time hold more promise in improving patient outcomes.19,20

A comparative study (NCT00245882) evaluated the effectiveness of different drug reminders for 2 groups of type 2 diabetic patients. The study aimed to assess the extent to which these reminders could contribute to reducing the incidence of hyperglycemic conditions.21,22 Results showed that active medication management by a provider in response to real-time glucose levels coupled with home telemonitoring led to a greater decrease in hemoglobin A1c compared with simple monthly telephone call reminders. These results further indicate that there is a need for reminders to be more involved so that patients can get the most out of their treatment regimens. Active monitoring of health and real-time alerts can make a difference in patient outcomes.

Cultural Sensitivity: Adapting Reminders to Diverse Perspectives

AI reminders are a versatile and adaptable tool that can be utilized for various conditions and diverse populations. The use of outdated reminder systems, such as pagers, is expected to decline, whereas newer technologies, such as AI-powered smartphone applications, are becoming increasingly available. SMS reminders are gaining popularity in treatments aimed at enhancing drug adherence due to the high prevalence of smartphones.23 Reminder-based interventions are primarily grounded in behavioral learning theory principles, which propose that both internal and external stimuli or cues influence behavior. This implies that a non-adherent attitude could be transformed with sufficient recurrence of outer signals or stimuli, such as reminders.24

The research conducted by Pop-Eleches et al revealed that administering SMS reminders once a week has shown significant improvements in treatment adherence among patients with HIV; however, daily notifications failed to show the same result.12 Memory issues have been observed among elderly patients, often leading to forgetfulness about prescribed medications. Similarly, adolescents risk missing their scheduled doses due to their social engagements and other activities. Zelikovsky et al discovered that activities such as spending time with friends and engaging in social events often result in forgetfulness among adolescent patients with renal transplant.25

Among adolescents, the prevalence of cell phone usage is high, so SMS reminders may be an effective method for reminding this patient population. In a study conducted by Miloh et al, it was observed that text messaging positively impacted the adherence rates of young patients with liver transplant.26 Investigators of another study (NCT04317573) discovered that a reminder gadget could benefit patients with glaucoma as well.27

According to results of a study conducted by Wise and Operario, a significant improvement in adherence was observed in patients following the implementation of reminder systems.28 As per their findings, of all the studies they reviewed, 50% showed promising results. These findings can help in the development of effective strategies for managing patients with HIV and improving their health outcomes.28 The results of these studies all point toward a common conclusion: More involved and technologically advanced reminder systems are contributing to improved adherence and patient outcomes.

Conclusion

About the Authors

Azhar Hussain, DHA, MBA, is a PharmD candidate at the Touro University College of Pharmacy in New York, New York.

Syed Ahsan is a graduate of Stony Brook University in Lake Grove, New York.

Medication adherence is a key challenge in effectively treating chronic diseases. To address this, AI-integrated reminders and alerts are increasingly being used in health care to assist patients in adhering to prescription regimens. These innovative tools can be customized to meet the patient’s preferences, including communication channels and the frequency of reminders, and can provide valuable insights before the onset of the disease. Additionally, chatbot reminders can be used to create intuitive conversational interfaces that deliver personalized instructions to patients while providing physicians with medication adherence statistics and valuable patient health information. Furthermore, incorporating brief segments of health games and transforming reminder apps into rewarding quests may improve patient motivation to adhere to their treatment plan and care for their health. Though additional research is necessary to assess the long-term effectiveness of these reminder systems, we can be certain that further improvements in AI technology today can pave the way for profound impacts in the future.

References

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The authors have no disclosures.

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