The Electronic Medication Management System—EMMA, for short—is a sculpted off-white box with a small black screen nestled in its center. It resembles the clunky computers of the early '90s, and it works like a personal computer—only for prescription medications. EMMA stores, organizes, and dispenses up to 10 different drugs, keeps track of complex dosing schedules, maintains printable records of a patient's medical history, and sets off alarms whenever it's time to take a pill. EMMA also links to the Internet, allowing a physician or pharmacist to monitor and refine a patient's treatment regimen from afar. Approved by the FDA in June and slated to go on sale to the public next year, EMMA will be a sophisticated—and probably expensive—solution to a widespread problem: Many Americans fail to take medications correctly, or at all.
Medication nonadherence, as it's called, leads to worsening illnesses, preventable deaths, and an estimated $177 billion in additional medical expenses a year, according to an August report by the National Council on Patient Information and Education. Overall, say experts, as many as half of patients may fail to take their prescription medications correctly. While the causes are many, here are some common reasons that people skip pills:
Forgetfulness. For people prone to forget—whether merely out of absentmindedness or because of severe cognitive decline—pill-taking needs to be part of a daily routine. If your prescriptions permit, consider taking most or all of them at the same time: The fewer interruptions involved in taking your medicine, the less likely you'll be to forget. Experts also suggest that you combine taking your medicine with another established daily activity: Pop pills just after or before a particular meal, right before bed, or upon waking up. Weekly "pill minder" boxes, personal planners, and medication diaries are also recommended. Some people arrange to receive daily automatic E-mails, set special alarms on their watches or cellphones, or schedule reminders on their PDAs. Your pharmacy or doctor's office may be willing to make daily phone calls or provide other reminders.
Cost. If cost is a significant barrier to carrying out your treatment, share your concerns with your healthcare providers. The medicine your doctor has prescribed might not be the only, or the cheapest, drug of its kind, says Michael Wolf, an assistant professor of medicine and director of the Health Literacy and Learning Program at Northwestern University's Feinberg School of Medicine. Find out which drugs are covered by your insurance, and whether cost-saving generics are available, says Wolf.
Chain pharmacies sometimes offer discounts for people facing financial hardships. And some people can qualify for treatment at a community health clinic or a federally qualified healthcare center, both of which may offer treatment at reduced costs. Community health centers "often have a social worker who will help people fill out applications" for pharmaceutical company discounts, says Thomas Croghan, a professor of medicine and psychiatry at Georgetown University's School of Medicine. "If you don't have any insurance," he adds, they "are very good about looking for any [alternative] sources of funding."
Confusion. If you can't understand a prescription label, you'll have a hard time knowing how to take the pill. Though non-native English speakers and people with low general literacy are particularly likely to get confused, experts say that anyone—even the highly educated—can misunderstand seemingly simple label instructions like "Take two pills twice daily." A strong ability to understand labels and other health information, follow treatment instructions, and participate in conversations with healthcare providers has been linked to higher levels of health and longevity. Still, "the average American reads at the eighth-grade level, whereas most health materials, especially informational leaflets that a patient gets from the pharmacy, are written at the college level," says Sunil Kripalani, an assistant professor at Emory University's School of Medicine.
If you have trouble following doctors' instructions, or are especially anxious in healthcare settings, consider bringing someone with you to the doctor's office, hospital, and pharmacy. "It's always good to have someone else there to help you navigate that information," says Wolf. "Bring a family member or a friend [to act] as a support and a surrogate."
Unrelenting Treatment. Chronic conditions like asthma and diabetes require long-term or lifelong management, often involving difficult medication routines that can be exhausting to maintain. For those with type 1 diabetes, for example, self-managed treatment is a pervasive fact of life that demands constant attention (read a profile of a patient). Not surprisingly, those with chronic conditions are thought to be at high risk for medication nonadherence.