New efforts to remind patients to take pills

The Electronic Medication Management System -- EMMA, for short -- is a sculpted off-white box with a small black screen nestled in its center. It works like a personal computer -- only for prescription medications. EMMA stores, organizes, and dispenses up to 10 different drugs, keeps track of complex dosing schedules, maintains printable records of a patient's medical history, and sets off alarms whenever it's time to take a pill.

EMMA also links to the Internet, allowing a physician or pharmacist to monitor and refine a patient's treatment regimen from afar. Approved by the FDA in June and slated to go on sale to the public next year, EMMA will be a sophisticated -- and probably expensive -- solution to a widespread problem: Many Americans fail to take medications correctly, or at all.

Medication non-adherence, as it's called, leads to worsening illnesses, preventable deaths, and an estimated $177 billion in additional medical expenses a year, according to an August report by the National Council on Patient Information and Education. Overall, say experts, as many as half of patients may fail to take their prescription medications correctly.

While the causes are many, here are some common reasons that people skip pills:

Forgetfulness. For people prone to forget-whether merely out of absentmindedness or because of severe cognitive decline-pill-taking needs to be part of a daily routine. If your prescriptions permit, consider taking most or all of them at the same time: The fewer interruptions involved in taking your medicine, the less likely you'll be to forget.

Experts also suggest that you combine taking your medicine with another established daily activity: Pop pills just after or before a particular meal, right before bed, or upon waking up.

Weekly "pill minder" boxes, personal planners, and medication diaries are also recommended. Some people arrange to receive daily automatic E-mails, set special alarms on their watches or cell phones, or schedule reminders on their PDAs. Your pharmacy or doctor's office may be willing to make daily phone calls or provide other reminders.

Cost. If cost is a significant barrier to carrying out your treatment, share your concerns with your health-care providers. The medicine your doctor has prescribed might not be the only, or the cheapest, drug of its kind, says Michael Wolf, an assistant professor of medicine and director of the Health Literacy and Learning Program at Northwestern University's Feinberg School of Medicine. Find out which drugs are covered by your insurance, and whether cost-saving generics are available, says Wolf.

Chain pharmacies sometimes offer discounts for people facing financial hardships. And some people can qualify for treatment at a community health clinic or a federally qualified health-care center, both of which may offer treatment at reduced costs.

Confusion. If you can't understand a prescription label, you'll have a hard time knowing how to take the pill. Though non-native English speakers and people with low general literacy are particularly likely to get confused, experts say that anyone -- even the highly educated --can misunderstand seemingly simple label instructions like "Take two pills twice daily."

A strong ability to understand labels and other health information, follow treatment instructions, and participate in conversations with health-care providers has been linked to higher levels of health and longevity. Still, "the average American reads at the eighth-grade level, whereas most health materials, especially informational leaflets that a patient gets from the pharmacy, are written at the college level," says Sunil Kripalani, an assistant professor at Emory University's School of Medicine.

If you have trouble following doctors' instructions, or are especially anxious in health-care settings, consider bringing someone with you to the doctor's office, hospital, and pharmacy.

Unrelenting treatment. Chronic conditions like asthma and diabetes require long-term or lifelong management, often involving difficult medication routines that can be exhausting to maintain. For those with type 1 diabetes, for example, self-managed treatment is a pervasive fact of life that demands constant attention.

For some chronic conditions, drugs that are prescribed to prevent long-term worsening of the illness may not offer immediate relief --or, as in some cases of hypertension, there may be no symptoms in need of relief. Either way, a patient may find it hard to stick to a daily drug regimen.

In other cases, a patient may feel better soon after beginning a treatment plan but mistakenly assume, without consulting a doctor, that the improvement is a sign that treatment can end.

In these situations, social support networks can be an invaluable. Robin DiMatteo, a professor of psychology at the University of California-Riverside, recommends having a family member, friend, or neighbor call or visit frequently to offer encouragement.

If you live alone or away from friends, or lack a strong support network, consider joining a community or hospital-based support group. "Make up for not having available help from others by seeking it out," says DiMatteo.