Medicine only helps if you take it properly. And adhering to an exact schedule of what to take, and when, can be challenging for patients who are forgetful or need to take several medications.
Doctors warn about the consequences and urge patients to use various techniques, such as using divided pill boxes or putting their pill bottles beside their toothbrush as a reminder to take their morning and bedtime medicines.
Still, only about half of patients take medication as prescribed, resulting in unnecessary hospital admissions and ER visits that cost the U.S. health care system an estimated $290 billion a year.
To help combat the problem, many doctors are trying a more high-tech approach: They're recommending smartphone apps that send reminders to patients to take their medications and record when they take each one.
"I think it's going to become pretty standard" for doctors to recommend them, said Dr. Michael A. Weber, a cardiologist at SUNY Downstate Medical Center. Weber began recommending apps to patients a few months ago and already has seen better lab results from a few using them.
"Some people say, `That's a great idea,'" Weber said. "Even ones who claim they're conscientious, like the reminders."
He said the apps are particularly helpful for patients with symptomless conditions, such as high blood pressure or high cholesterol. Those patients are less likely to regularly take their medications than someone with pain or an infection.
"I don't think they're going to change the world," Weber said, though he recognizes benefit of apps. Even so, he said smartphone apps won't do much to help people who simply don't like taking medicine, fear side effects or can't afford their prescriptions.
It's too soon to tell how well the apps keep patients compliant or how long they keep using them.
Darrell West, director of the Center for Technology Innovation at the independent public policy group Brookings Institution, said some doctors have reported better medication adherence, but there haven't been large scale studies on the effectiveness of such apps.
The apps began appearing a few years ago and now there are dozens.
Available functions include providing more detailed information on the patient's medication and illness, prompts to refill prescriptions, email alerts about possible drug interactions, doctor locators and more.
Some have symptom checkers, and one called iPharmacy can identify pills when patients enter their shape, color and imprinted text. Others are just for women on birth control pills or patches (myPill) or patients with complex chronic diseases, such as cancer (CareZone Cancer), diabetes (Diabetes Pacer, which also tracks blood sugar and exercise) or HIV (My Health Matters, from drugmaker Merck & Co.). For those patients, getting off schedule or ignoring symptoms can have particularly serious consequences.
Still more apps take distinct approaches. For instance, Mango Health lets users earn points for complying with their medication schedule. Those points can be turned into gift cards or charitable donations.
CEO and founder Jason Oberfest, formerly head of game platforms at MySpace, said Mango Health partners with doctors and health insurers who are recommending its app to patients and customers.
The app, featured in Apple's iTunes store, gives a history showing users daily results and point total, plus graphs comparing an individual's adherence to other app users.
According to the company, 46 percent of its monthly visitors use the app daily and 60 percent are still using it after four months. For widely used classes of drugs for depression, diabetes, high cholesterol and high blood pressure, the company claims at least 80 percent of its users take their meds as prescribed. That's compared to 59 percent or less in independent studies of overall patient adherence for those drug classes.
"We've heard from people using the application as old as their mid-'70s and older," Oberfest said, but it's especially popular with the 35-to-55 age group, people familiar with video games.
Here are some tips for choosing an app:
-Check whether it's available for your smartphone's operating system. Some are only available for one system or haven't been updated for the latest phones.
-Ask your doctor's opinion. Some may not be up on the different apps but have staff members who can help patients pick and install apps.
-Start with one of the many free or low-cost apps. Search your app store for "medication reminder."
-Think about what you'll really use. If you only want reminders to take your pills, that's all you need. If you're taking multiple drugs or change medications often, you might prefer an app with information on your condition, drug interactions and other details.
-To protect your privacy, pick one with password protection.
-If your life is hectic, consider one with a snooze function.