What’s a “Talking Pill Bottle?”
Just as it sounds, “Talking Pill Bottles” (TPBs) are devices designed to provide verbal information in conjunction with traditional pill bottles dispensed by pharmacies to aid in those with low health literacy. Ideally, a health professional (i.e. pharmacist) would record verbal instructions and cues for patients via a TPB, so the patient had a better understanding of what medication they were taking and pertinent instructions and counseling points. These things have been around for the past decade, more or less, and sell for anywhere between $10-$60 a piece. Nonetheless, take-up of such devices has not seen a large market and they still remain on the wayside as an intervention for patient care.
So what’s new?
Well, a recent publication in the Journal of the American Pharmacists Association (JAPhA) evaluated the impact of TPBs on those with low health literacy and hypertension as a tool to help improve efficacy and adherence to therapy. The study, “Addressing low health literacy with ”Talking Pill Bottles”: A pilot study in community pharmacy setting,” was conducted by Lam and colleagues in thanks to an NIH grant.
To get to the point, it was a 90-day RCT trial, conducted at two community health pharmacies (average volume of each store was 1700 scripts/wk), in Washington State and involved 134 patients. The average age of the sample population was 70, with an equal breakdown in genders, and most having less than an high school education. The breakdown was 66 participants in the standard treatment arm, and 68 in the intervention arm. All patients received counseling regarding HTN, and the primary difference being those patients with a TPB also had access to routine recorded messages.
So what did they find? Well, 70% of those with TPBs found them beneficial and favorable to use and helped them understand their medication better. However, only around 46% reported to listening to the TPB once a week, and 14% less than once a week or not at all. While easy to use, they wished that it could provide reminders of when to take their medications. As to whether it increased adherence or helped manage BP better, it’s a mixed sell. Adherence (a tough thing to measure) did not seem to be impacted at all, while BP had a statistical decrease in the intervention arm (which was a couple mmHg difference [-4.09 SBP/-2.42 DBP]).
What about Smartphones?
For me, the results aren’t necessarily startling, and for being conducted in 2010, it was a nice intervention experiment regarding the thoughts of patients on using such tools in their care. That being the case, this is 2017, and those methods are quite outdated. One example? Look at a recent project from Stanford’s Health++ Hackathon, called ‘Pharmassist.' Essentially, the concept is a sensor placed on a pill bottle that syncs with an app on a smartphone, whereby the patient places the bottle on the phone and it gives instructions and records adherence. This project demonstrates the lack of need for a large talking device, and just uses the smartphone that most people carry around with them all day. The other advantages can be talked about a length, but a run down would be further information on the app, tracking and refilling reminders (and online syncing to pharmacy to process refills), a way to contact a provider if a question arose, etc. It has a chance to impact those with low health literacy and visual impairments.
Where does that leave us?
So why do I think that JAPhA article is still relevant in relationship to what tech innovations are taking place today? Well, we still need research, even if it is slower paced than what technological innovations take place today. And Lam and colleagues demonstrated that there may be some therapeutic value to such TPB or talking reminders in daily care, and these interventions seem be accepted by patients. The main limitation, despite even what Pharmassist is trying to pull off (and all other ‘smart’ tools) is patient engagement with many patients falling off or such interventions. I think that is something from a design perspective we still are not at currently, and remains something to disrupt, and that those innovators take a look at this study to perhaps gleam some elements useful to their own project in the same landscape.