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Methods for Improving Compliance with Medicine Intake


(MICMI)





Facts about compliance with medicine intake:

  • Non-compliance with medicine intake is a problem in all age groups.
  • Elderly people use more than 60% of all prescribed medicine.
  • Only 50% of the patients in long-term medicine treatment are compliant with medicine intake.
  • The use of many drugs (polypharmacy) higher the risk of non-compliance.
  • Elderly people often have many different diseases (multi-morbidity) and are at higher risk for developing non-compliance.



Background of the MICMI-project:

The Department of Geriatrics, Aarhus University hospital, Denmark, and Vejlby Pharmacy, Risskov, in cooperation, conducts a research project to reveal if non-compliance can be remedied with the help of pharmaceutical reviews or with the help of an electronic device. These two methods are examined in two equally sized specific groups with 315 persons in each. As a basis for comparison, a third control group of similar size is examined. The examined persons are all 65 years old, or older, and use more than 4 different drugs daily. They have been chosen and assigned randomly into one of the three groups.

To evaluate the chance of non-compliance in these three groups, the team conducted three home visits, asked the participant’s questions from a questionnaire, took pictures and afterwards counted all the drugs the person concerned had at the very beginning of the study. This process was repeated after six months, and again, at the very end of the study (twelve months).  After this, the consumption of each drug (established by a tablet count) was compared with the amount of tablets the person had bought. The information on amount of tablets purchased was obtained from the Health Insurance Prescription Register. As a result, it was possible to see how many tablets the person concerned had consumed in the research period. Additionally, the research group examined the Danish Medicine Agencies Internet portal: the ‘Personal Electronic Medicine-profile (PEM)’. This was to allow an estimated non-compliance with factual medicine intake. The PEM has a built-in visual compliance page, making it possible to see if the amount of medicine purchased frequently by a participant for a year, also lasted one year. In the event of a participant’s purchased medicine being used up without the participant purchasing new supplies, the PEM showed a ‘gap’ in the timeline of the graphical presentation of compliance.

By examining a participants PEM profile, differences in compliance in three groups can be evaluated. PEM has not yet been evaluated in regards to non-compliance. The research group has therefore compared (non)compliance in PEM, against participants own statements on their medicine consumption. Participants own statements are obtained during home visits. A third method to track a person’s compliance is with the aid of an electronic-reminder device. The device enabled a built-in registration of all medicine consumed during the day.

   

     Aims of the MICMI-project:

  • To figure out if it is possible to find an at-risk group for non-compliance among the elderly with polypharmacy and if this can be achieved with the help of an electronic compliance database called Personal Electronic Medicine-profile (PEM).
  • To figure out if an intervention with en electronic reminder-system, or pharmaceutical care can improve compliance in the group.

   

Inclusion procedure:

                                                      Inclusion criteria:

1. municipality of Aarhus,

2. aged ≥65 years,

3. ≥5 subsidized drugs

According to the inclusion criteria eligible participants were identified from the national health insurance population register and assigned  randomly into one of the three groups.



 

    Interventions against Non-compliance:

                                                       Pharmaceutical review intervention:

     1. Medicine-regime review

     2. motivation

     3. information

     4. supervision

     5. contact every third month (telephone call)







                                                      Electronic reminder-system intervention:

1. Sends a signal after press on the red button to confirm the intake.

2. Registration on a safety stored server.

3. Reminder-signal to participant at the intake-times when intake forgotten.










    The Personal Electronic Medicine-profile (PEM):

  • Established by the Danish Medicines Agency.

  • PEM is based on the National Prescription Database.
  • Every Dane has his/her individual medicine-profile on the web (PEM).
  • PEM contains a graphical presentation of compliance, calculated by daily dosage, number of tablets purchased, and expected time to refill.
  • Whenever a prescription is not redeemed in time, the graphical presentation shows a gap in the time axes.

      


 Screen-shot of the original Danish Personal Electronic Medicine-profile (PEM):





Link to the official information on PEM (Danish Medicines Agency):

http://laegemiddelstyrelsen.dk/en/service-menu/about-us/the-medicine-profile--citizens-medication-overview

 

Visions:  

PEM, a large investment, established and maintained by tax-payer’s money has been available online for 5 years, but has not won wide usage. Hopefully our project will serve to raise awareness about the potential and usability of PEM. The research group believes that a combination of ‘Pharmaceutical care’ as an already established service for improving person’s medicine compliance, in combination with telemedicine can serve as methods for improving compliance with medicine intake and can contribute to saver and better supply of drugs in the future.




Link to the interview about the electronic reminder (Danish):

http://infolink2003.elbo.dk/apotekerforeningen/dokumenter/doc/9204.pdf                                                                        

                                                                                          

Link to the questionnaire. (Danish presentation of the study - Appendix):

https://sites.google.com/site/philharbig                                                                         

                                                                                          

     

Last updated: January 11, 2012