Northwell Health Uses Digital Health to Address Medication Adherence

The New York Health system is launching a new project that will use tech-enabled prescription bottles and remote monitoring to address medication adherence in patients with high risk of cardiovascular disease and a low rate of following doctor's orders.

Northwell Health is launching a clinical trial that will use tech-enabled prescription bottles to track medication adherence among members of New York’s Black community who are living with cardiovascular disease (CVD).

The program, managed by the Feinstein Institutes for Medical Research, the scientific arm of the New York-based health system, aims to determine how to develop behavioral interventions that will move the needle on CVD in a population at high risk.

“Cardiovascular disease is a major driver of death, particularly among people in the Black community,” Mark Butler, PhD, an assistant investigator at Feinstein’s Institute of Health System Science and principal investigator on the new trial, said in a press release. “Understanding how to promote adherence to life-saving medications is one of the best ways we have to shrink that disparity.” 

As of 2018, Black Americans were 30% more likely to die from heart disease than non-Hispanic whites, according to the US Department of Health and Human Services’ Office of Minority Health. At the same time, Black women are 62% more likely than their non-Hispanic white counterparts to have high blood pressure, and while Black men and women are 40 percent more likely to have blood pressure, they’re less likely to be taking action to manage their chronic disease.

The reasons for this are myriad, and include a lack of access to resources that would help with chronic care management, also considered a social determinant of health. The Northwell Health project looks to address that barrier through digital health technology.

The program will enroll 42 participants in a virtual care platform, giving each a prescription bottle that collects data on the dose and timing of when cholesterol-lowering medications and statins are taken orally. That data allows caregivers to track medication adherence, and to send text messages to remind or encourage users to take their medications.

With statistics suggesting half of all prescriptions filed in the US aren’t being followed correctly by patients, the project’s primary goal is to increase medication adherence among participants by at least 20 %. That would provide evidence that programs like remote patient monitoring can prompt patients to follow doctors’ orders.

That’s a key component to any project that looks to push care out of the doctor’s office and into the home. Healthcare outcomes are predicated on the patient following doctor’s orders. If the patient isn’t doing what the doctor tells him or her to do, then outcomes will be affected. With digital health, care providers can now check in on a patient at home, monitoring adherence and adjusting the care plan if it’s not doing what it should be doing. This, in turn, should lead to better outcomes, including reduced healthcare costs and a better quality of life.

In addition, researchers will be collecting information on what they’re calling the ideal “intervention dose.” They’ll be using multi-behavioral change technique (BCT) intervention, which measures behavior, monitoring, goal-setting, action planning and prompts to encourage positive behaviors to determine the best frequency of text messages needed to meaningfully improve medication adherence.

That’s the holy grail for digital health researchers: finding the right balance of virtual “touches” and links to appropriate resources that can compel a patient to modify his or her behaviors. Too few, and the messages bounce off without being taken seriously; too many, and the patient feels pressured or overwhelmed and veers away.

Rsearchers see a bright future for digital health programs that address medication adherence because the platforms allow them to reach out to patients at home, when they’re taking (or not taking) their prescribed medications, rather than waiting for them to come to the doctor’s office or clinic to talk about what they’ve been doing over the past few weeks or months.

That’s especially important to care providers dealing with underserved populations who may not want or be able to visit the doctor’s office or clinic on a regular basis.

"To improve healthcare outcomes for all, we need to identify innovative solutions that address the inequities that currently exist," Emmet Conlon, Head of Healthcare at TD Bank, which provided a $150,000 grant to the Feinstein Institutes for the project, said in the press release. "We know cardiovascular disease impacts the Black community differently. We hope that through this investment we can help identify ways to address inequities and improve health outcomes for vulnerable populations."