patient needs. Instead, one can expect a variety of
electronically monitored packages to emerge as the
recognized need for such information grows.
Consider the following scenario: a 60-year-old
patient is diagnosed as having high cholesterol
levels and is prescribed a once-daily cholesterol
synthesis inhibitor, essentially life-long therapy.
The patient has a certain tendency to forget
doses, which can be minimized by use of a simple
reminder device. Perhaps, with practice, the patient
develops a strong routine of drug intake, linked to
some regular routine in his life. If that occurs, the
reminder device becomes superfluous, although it
has served its purpose during the start-up phase of
treatment, to make the patient aware of the fre-
quency of missed doses. Meanwhile, the conse-
quences of missing an occasional dose of
cholesterol-lowering drug are, as far as anyone
knows, negligible. After a decade of treatment,
however, the patient develops coronary heart dis-
ease with congestive heart failure, and now is in a
situationwhere thepunctualmaintenance ofastrict
regimen is essential to prevent hazardous retention
of fluid. In this setting, the types of errors that had
little or no consequence for cholesterol regulation
can create major problems: omission of the daily
diuretic dose for as few as three days in sequence
can trigger acute pulmonary congestion, requiring
hospitalization that costs on the order of $10 000. If
the patient’s condition is additionally complicated
by chronic obstructive pulmonary disease, the
impact of fluid retention is all the more severe,
with even less latitude for error.
In this rather common scenario of disease pro-
gression, one sees how the changing nature of
drugs, diseases, severity of diseases and comorbid-
ity can radically change the medical and economic
implications of compliance errors.
The type of devices needed to accommodate this
particular patient can be as follows:
A device with an acoustic or visual reminder
for the patient and a memory capability so the
treating physician will get that patient’s actual
history of dosing. When a strong routine exists,
then this device may be used only sporadically to
check if the patient is continuing to dose satis-
factorily.
For elderly patients with multiple diseases and
multiple medications, an electronic dose organi-
zer may help them cope with the more complex
regimens.An effective program of medication manage-
ment may prevent the patient’s having to aban-
don home-based care: an obvious issue in both
the economics of care and the quality of life.Of course, some patients will not agree to any kind
of monitoring, but the hazards and costs of sub-
optimalcare have, astheybecomewell understood,
a way of shaping human decision making. One
looks back at the way in which patients with dia-
betes switched from a single needlestick each day
to as many as four injections of insulin and four
additional needlesticks for blood sampling, hardly
something onewould do unless therewere compel-
ling reasons.What about the patient?
In this world of technology, the patient should
come before, not after, the technology. Technology
by itself will not solve all the problems created by
erratic compliance. Technology is a tool that can
help healthcare professionals identify, track and
potentially solve many of the issues created by
partial and poor compliance. The patient will
decide which type of intervention or what level of
monitoring he/she wants to have. It will not be
helpful to have the patient forced into a world
that he/she does not understand. When all is said
and done, the patient will have to perceive thevalue
of available services, adopt one of them and adapt
to it.What about the health professionals?
PhysiciansPhysicians will have to heighten their index of
suspicion of partial or poor compliance when
drug responses are disappointingly small or absent.
One might reasonably expect that the clinical27.16 WHAT SHOULD INTERACTIVE PACKAGING OFFER TO IMPROVE PATIENT COMPLIANCE? 369