Closing the adherence gap: Supporting medication adherence with technology and design
How to move beyond the patient and drive better outcomes
Medication is one of the most critical levers the health system has to improve outcomes, but adherence is a tricky behavioral problem that limits the effectiveness of treatment at scale.
Medication non-adherence is one of the most challenging issues providers and payers deal with, and solving it would unlock better outcomes, savings, and efficiency across the healthcare system. As discussed in our panel on early detection, moving from detection to treatment requires building new technology that understands patients. Managing medication for these treatment plans will require building technology that fits seamlessly into patient’s lives.
Across the health system, medication adherence impacts organizations in different ways. For pharmaceutical companies, patient adherence is directly tied to commercial success. For health technology companies, medication is one of the biggest levers for improving outcomes in the populations they serve. Medical device manufacturers have been trying to navigate this growing demand with portfolios of connected products, from smart auto injectors to inhalers, that have yet to find large scale adoption.
Especially in the context of AI in health, the value of real time, longitudinal medication use data continues to grow. Health AI can better predict risk, monitor progress, and intervene earlier when informed by accurate data sources. There is a growing ecosystem of devices and wearables generating longitudinal health data, but medication-use data is unique. It can’t be monitored easily with these existing devices, so the opportunity for a new device is clear.
While solving for adherence means potentially building a device, a device alone won’t solve adherence.
One size does not fit all
Not all non-adherence is the same. From forgetfulness to side effects and cost, reasons for non-adherence vary wildly across conditions and people. Designing for adherence means deeply understanding who you’re building for. The more focused a problem can be (i.e. solving for a specific population’s need for payment assistance) the more targeted, and successful, your solution can be.
Formative studies with a specific user group can uncover insights that drive feature development and alignment within a team. By meeting with patients, a product or service can be designed with their specific issues in mind. Smart Design has a long history of running user research to identify product opportunities, and then working with teams to commercialize these concepts.
Patients may face anxiety and uncertainty when starting a self-injected medication, often leading to longterm adherence issues. A leading biopharmecutical company needed a way to improve onboarding and longterm adherence rates. They approached Smart Design to help them redeisgn their packaging system, through the lens of human-center design. We made sure to put the right information in the right place at the right time, integrating approachable content and a clear information hierarchy directly into the physical experience. With this flexible packaging framework, we helped patients feel more confident from the start, all while giving our client a scalable solution to streamline packaging development across its injectable portfolio.
How to track medication use
Once patient insights have informed the structure of an adherence program, teams must decide how medication-use data will be captured. Because medication tracking requires interfacing with the physical world, there are many approaches, each with its own tradeoffs. The right solution depends on the specific use case and population.
Pharmacy integration
Pull data around refills directly from a patient’s pharmacy. While this data is less accurate and timely than from daily use, it doesn’t require a device. This is one of the most common approaches within digital health, as it is an entirely software-driven approach.
Integrated tracking
Build sensors into medication packaging, such as through a pill bottle, pill organizer, blister pack, smart injector, etc. Developing an effective design means balancing a system architecture against how precisely dose confirmation data is needed.
Automated dispensing
Create a device that manages dosing for patients directly, where medication can be tracked as part of the system. Due to the added cost and complexity of this type of device, this may be most appropriate for use cases with a large addressable market like senior care or chronic condition management.
Biomarker linking
Develop a biomarker that acts as a proxy for medication use and is measured via wearables, PPG sensing, or an at-home test. This path is scientifically exciting, but very challenging due to the clinical data needed to prove it. The economic benefit of a potential adherence program needs to be weighed against the cost to generate clinical evidence early in the development cycle.
A deep history of failed products
From smart pill bottles to reminder apps, many medication adherence solutions put patient forgetfulness front-and-center. Many of these products rely on audio/visual cues or app alerts to notify users to take medication. These signals only go so far. They’re limited in how they address many of the root causes of non adherence: unpredictable side effects, managing costs, understanding dosing schedules, and medication hesitancy.
No single tracking device can solve all of the above and the ever growing number of device-centric attempts isn’t for a lack of trying. The challenge as a product development team is to shift your viewpoint from making a tracking product to a responsive one, where medication use data is a key input. In this framework, even though you may build a custom medication tracking device, adherence outcomes are not tied to the hardware, but from the information it generates. Developing both the program and the device through human-centered design can go a long way to understanding and solving for barriers to adherence.
Medication adherence is about outcomes, not reminders
Many of these medication adherence products were focused on reminders, and, because of that, they rarely connected into health programs that informed broader care plans. Many digital health programs today rely on data that provides an incomplete and lagging understanding of patient medication use.
As digital health products further integrate AI, medication use data will become a powerful input for understanding patients to improve outcomes. AI-enabled programs will need higher-fidelity data to identify patterns, respond to changes, and determine when a patient may need support. This shifts the goal from reminding someone to take a dose toward understanding medication use in the context of their broader health.
The challenge is that high-fidelity medication use data is difficult to capture. It exists primarily in and around the medication itself, or through the body’s response to it. This creates an opportunity for new products and devices that can capture meaningful data while fitting naturally into a patient’s life.
These products may not provide value on their own, as their value comes from how they connect patients, providers, and care programs together. Designing them requires a clear understanding of the larger care experience and the specific outcomes the system is trying to achieve.
How human-centered design can move the needle
An iterative design process that links formative user research with design iterations can be highly effective at developing solutions that stick. Different types of studies can generate various insights that drive meaningful design direction. Starting with general needs finding within a user population can help point your team in a direction around what to solve. A design team then takes those pointers to generate concepts that are fed back into usability focused research sessions.
Running these loops to refine the design sharpens the product you plan to build. When the patient is at the center of this process, it lowers the risk that your launched product can fit into their life effectively.