A model to personalize scheduling of complex prescriptions

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Abstract

Medication adherence tends to affect the recovery of patients. Patients having poor medication adherence show a worsening of their condition and/or increased complications. Unfortunately, between 20% and 50% of chronic patients are unable to manage their medications. This study proposes a model to improve the patients’ medication compliance by reducing medication frequency.

Published studies have shown that, based on the patients’ lifestyle, simplification of the medication frequency and remodeling of the medication schedule is able to help improve medication adherence. Therefore, this study tried to simplify medication frequency by combining therapies. Moreover, by adjusting according to lifestyle, the study also tries to remodel medication timing in relation to mealtimes to create personal medication schedules.

In this study, we used 19,393,452 outpatient prescriptions from the National Health Insurance Research Database to verify our system (algorithm optimized). At the same time, we examined the differences between the frequency summarized by general public and experts’ advice medication behavior. Compared with the experts’ advice method, this system has reduced the medication frequency in about 49% of prescriptions.

Using combined medication to simplify medication frequency is able to reduce the medication frequency significantly and improve medication adherence. Furthermore, this should also improve patient recovery, reduce drug hazards and result in less drug wastage.

Introduction

When patients receive prescription, they have to take medications as prescribed by their physician in order to get cured, however, a good number of patients fail to comply with the complete treatment plan prescribed by their doctor once they start recovering. One study showed that 30–50% of prescription drugs are not taken correctly [1] and obviously the level of medication adherence has an effect on the degree and speed of recovery. Poor medication adherence leads to disease progression, complications, side-effects and even death [2]. A study at the New England Healthcare Institute indicated that in the USA, annual healthcare expenses caused by poor medication adherence cost a total of USD 290 billion [3]. Improving medication adherence among patients is a big challenge and needs to be addressed.

Medication adherence is associated with patient's behavior; it is influenced by a range of factors that are manifold and complex. Researchers have attempted a number of methods to improve patient medication adherence with the aim of controlling and improving the patient's condition [10]. These approaches include improving paper medication schedules to help patients who are less well educated to take their medication correctly [4], using electronic pill reminder dispensers [5] so that the user is reminded to take their medicine on time and by sending SMS (Short Message Service) messages to remind patients to take their medication on time [6].

This system (algorithm optimized) is designed by considering the different characteristics of the drugs involved, directly convert the medication frequency prescribed at the hospital into a suitable medication guideline. It would also make changes and adjustments in accordance with the daily routine (life-style) of each individual patient. In this way the time of medication administration can be fully integrated into the patients’ life-style. We hope this model could reduce the medication frequency effectively and thus enhance medication adherence, which will help in patients’ recovery and safety.

Section snippets

Prescriptions and medication adherence

In Taiwan, polypharmacy is a common practice. When a prescription is written, physician is not sure that patients will be in compliance with his/her instructions. One of the ways to improve compliance is physician must communicate with patient; explain the disease so that patient understands his/her own health situation [7], [8]. A proper explanation of the disease can motivate patient to participation in the treatment plan, and can possibly improve medication adherence. A good communication

Medication frequency

Many of the reviewed retrospective studies indicate that a simplification of the medication frequencies enables to enhance medication adherence. However, it must not be expected that medication adherence can be enhanced simply by reducing medication frequency, since medication adherence is not influenced by medication frequency alone [15].

A study by Claxton showed (Fig. 1) that there is an inverse relation between daily medication frequency and medication adherence. In other words, the more

Medication frequency guidelines

In the study, we used the frequency table of the Taipei Veterans General Hospital as a basis for drawing up the frequency guidelines. This frequency table consists of a total of 144 different frequencies. Based on these 144 different frequencies we carried out categorization and then drew up various different medication guidelines. However, because certain frequencies that are too short in terms of medication intervals, these are not suitable for a medication schedule and any created reminder

Results for average medication frequency per day

We calculated the average medication frequencies of all prescriptions according to the total number of drugs received by patients. These were categorized into one to nine drugs and more than ten drugs. Fig. 2 shows that there is a positive correlation between the average medications frequencies with the increasing number of drugs prescribed.

Results for medication frequency after experts’ advice and system (algorithm)

We made a categorized prescriptions based on the total number of drugs received by patients into one to nine drugs and more than ten drugs. Fig. 3 shows

Discussion

Poor medication adherence will have negative effect on patients’ recovery, so an appropriate intervention to help patients improve their medication adherence is desirable. This system not only aimed at helping patients to reduce medication frequencies but also integrated medication schedules with life-style. In this study, we therefore tried to integrate drug administration times with patients’ daily routine and thus reduce medication frequency. This ought to enhance medication adherence, and

Conflict of interest statement

None.

Acknowledgements

This work was funded in part by grants DOH100-TD-C-111-008 from Department of Health Taiwan and NSC 99-2218-E-038-001 from National Science Council and SKH-TMU-92-41 from Shin-Kong Wu Ho-Su Memorial Hospital and Taipei Medical University.

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