Helping Patients to Follow Doctors' Orders

It is pretty well-established that for many diseases, both chronic and infectious, taking your medicines as prescribed (number of pills, frequency, duration of treatment)--what we call medication compliance--is an important way to manage your health.  Especially for chronic diseases, following your doctor's advice can help prevent costlier complications as well.

But this is not only the case in the developed world.  In less-developed countries, it is often difficult for patients to see the value of finishing a prescription, especially if symptoms have disappeared. 

Take drug-resistant tuberculosis, which is a big problem in many poor countries.  The treatment for TB is antibiotics for 6-months, which have side effects like nausea, and patients often stop taking them, which can lead to drug-resistant forms which are costlier to treat.  How to get them to comply?

Researchers at MIT's Innovations in International Health program came up with an ingenious/bizarre monitoring system that combines cheap, paper-based diagnostics with text-messaging technology to reward patients for adhering to the drug regimen.   

The MIT team developed a basic paper-based test that detects metabolites of the TB drug in urine. The metabolite reacts with chemicals in the paper, revealing a numerical code. A patient would take the test daily and text the code to a central database. Those who take the drugs consistently for 30 days would be rewarded with cell-phone minutes.  The pilot program ran in Nicaragua, with a larger trial currently running in Karachi, Pakistan.

I would have LOVED to have been in the brainstorming session for that one.  But there are a few simple lessons that we can use here in the US as we embark on what will surely be radical reform to our healthcare system:

1. Patients, especially those with chronic diseases, need to take their medicines as prescribed to manage their health and prevent complications, which cost more to treat.
2. Patients must see the value of taking their medicines, especially when symptoms are not a daily reminder of their conditions.
3. Patients often need to be encouraged, supported, and rewarded to continue their treatment.

Sometimes the most off-the-wall idea should not be dismissed.