Some doctors now require patients to record a video of themselves taking their pills for the sake of proving medication adherence. One telehealth expert has concerns about this practice and doesn't see it sticking.At a time when taking and sharing selfie photos and videos have become commonplace, it's no surprise that someone would come up with the idea of "selfie medicine."Selfie medicine requires using a mobile app to record a video of themselves taking prescribed medication for the sake of proving adherence. On one hand, it seems like an innovative solution to a major healthcare problem, as statistics show that up to 50% of U.S. adults do not take their medication as prescribed. But the practice also raises some valid concerns."I think it can be part of an acute care adherence plan," Shital Mars, CEO of Progressive Care, told MD+DI.Currently, selfie medicine is being used to monitor adherence in patients with highly infectious diseases such as tuberculosis where the medication regimen has a short period and the importance of never missing a dose is very high, Mars said.If the selfie medicine trend were to extend into medication monitoring for more common and chronic conditions, such as hypertension, however, Mars isn't convinced that it will become anything more than a fad."You're on those medications for years at a time, if not forever, and you take multiple medications throughout the day," she said, referring to things like blood pressure medication or cholesterol pills. "I just don't fathom seeing a person wake up in the morning going 'let me activate the app and take my medication and send it to the doctor, and then at noon do the same thing and at bedtime do the same thing ... I just don't see them doing that for long stretches of time."Mars compared the trend to other self-compliant mobile health devices such as fitness trackers or weight loss programs where even highly motivated users often abandon the tech after about six months.So let's say, for argument's sake, selfie medicine does catch on. Mars said there are still a lot of questions that need to be addressed."What happens to that information once you do that? Is the doctor going to look at it? What are the consequences of this? Is the doctor now going to harass me or say that they're not going to treat me now if I don't use the app? Is that really what we want?" Mars said.That's not to say that the idea is destined to fail. Mars said a selfie medicine model could work for some patients if there is a monetary value or other meaningful rewards to using the app, such as a discount on insurance or a flat fee for the patient everytime they engage with the app to show compliance.But at the end of the day, data security and patient privacy must be addressed. If a hacker were to access those videos of patients taking pills, they not only have a name but a face, Mars pointed out.And this is all coming from someone who knows all about the challenges involved with getting people to take their pills. Progressive Care is a South Florida health services organization that focuses on proactive patient engagement."Medication coaching, medication reconciliation, really communicating with the patient, with the doctor, with the insurance carrier, [and] with the caregiver about a medication regimen and really reaching that patient not just on an intellectual level, but on an emotional level," Mars said. "A lot of times the reason a patient may not take their medication is because they don't like it or they don't believe in it ... so we really have to dig in deep and say 'this is what these medications or for, this is why you need to take them'. We go through and do the whole insurance process in a proactive way.""Patients, a lot of times, will become nonadherent when their refills are due," she said. "A month ahead of time we will communicate to the patient that they're out of refills and the doctor wants to see them ... we offer next-day and same-day delivery of medication. We know when you're out of medication."Or at least, when you should be out of medication."If they say, 'Oh, i don't need any, I have so many', then we will say, 'wait a minute, why do you have so many? You're supposed to be taking these meds three times a day'."Such interactions tend to uncover the patient's rationale for not taking their medicine as prescribed, such as cost, Mars said. A lot of patients will ration their medication instead of taking it as prescribed because of cost. When that comes up, she Progressive Care intervenes by talking to patients about their co-pays and seeing if there may be a cheaper alternative medication available that the doctor can prescribe instead."Sometimes we'll send a van to drive the patients to the doctor, sit with them with the doctor, and go over medications with them so that they really understand," she said.It's an awful lot of work on Progressive Care's part, but so far it seems to be getting results."Our patients we are consistently delivering above 90% adherence rates," she said, adding that the company's most recent Humana scores show that their Humana patients are 97% to 98% adherent with their medication."The company isn't opposed to using technology to tackle healthcare challenges, however. Progressive Care is developing an app of its own, Mars said, that would be voluntary and make it easier for patients to access a pharmacy when they have questions about their medication."For instance, you're taking 10 different medications, you're starting to not feel good, but you're not sure which of the 10 medications is actually giving you this particular side effect," she said. "The app would allow you to communicate with the pharmacy without having to walk in ... almost like a FaceTime conversation. It's not something that will mandate adherence, but facilitate the pharmacy's monitoring of the patient's progress and adherence to their medication."
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