As an engineer, I'm always interested in inventions that make the delivery of good medical care more effective, efficient, or safe.
Oral medications are a necessity ripe for improvement. It's tough to find worldwide statistics on this topic, but in the US, at least, 50% of us have used a prescription medication in the past 30 days. If you add in over-the-counter medications, that number must be much higher. And yet adherence to oral medication is terrible, and available interventions don't work very well. Our best guess is that adults in the US take their medication correctly only about 50% of the time, and this costs all of us over $100 billion annually in avoidable hospital admissions.
Even a slight improvement in the reliability of getting oral medications into patients would help all of us. One way to increase correct medication use would be to reduce the number of doses that each patient needs to take. We all know better than to prescribe TID medications when we can help it, for example when choosing an antibiotic. I suspect that the curve of compliance vs doses continues upward, though.
Dosing less frequent than daily would be especially helpful in certain patient populations. Consider how much better life could be for people who don't have to remember their antipsychotics every day. And I imagine that the treatment of tuberculosis per dollar spent would improve drastically with less than daily contact needed.
Enter this unique invention I came across the other day while avoiding loading the dishwasher (sorry, Mary). This is a capsule taken like any oral medication. When it enters the stomach, it deploys a structure that hangs out there over 7 days, slowly delivering its payload. Then at the end of the week it dissolves and continues on its merry way through the gut. The data in healthy volunteers look good. Whatever is going on behind the scenes must also be promising, because in June, Lyndra Therapeutics, the company responsible for this technology, completed Series C financing to the tune of $60.5 million, and they report almost $250 million overall.
Lyndra therapeutics' oral, ultra-long-acting, sustained-release capsule, and the contents expanded as they would be in the stomach. Photo kindly provided by the company at Kathryn Hitchcock's request.
It seems that clinical trials are upcoming, and I sincerely hope they'll proceed swiftly and successfully. In the meantime, what's a doctor to do? Every day I talk to patients about medication compliance, but it's an unsatisfying conversation because I don't have great advice on how they can improve matters, even when highly motivated. It turns out that being married and having more formal education are correlated with better rates of correct medication use, and having small children with worse performance, but I don't think anybody is going to take my advice on those topics.
Getting a daily phone call may be useful, and we certainly have that technology (we can just ask the folks who want to talk to me about my car's extended warranty), but I don't have the ability to purchase and fire up such a system. It turns out that frequent contact with healthcare providers and actually talking to patients about the topic does improve matters. That means that radiation oncologists, who see their on-treatment patients every week, can do a lot of good here. I strongly recommend that patients use a pillbox instead of taking each medication from the bottle. I also recommend that they have a family member check the box, as my older patients don't have a great sense of their own ability to fill the box correctly.
What strategies do you use to improve self-administration of medication in your patients?
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Cite this: Kathryn E. Hitchcock. New Technology May Improve Medication Compliance - Medscape - Aug 04, 2021.