The Hidden Epidemic: Medication Mismanagement

Posted on November 11, 2016 by Hayden Schoen

There is a hidden health epidemic in the United States - 125,000 people die every year due to mismanaged medications and related causes.2 These dire consequences (including an estimated $300 billion dollar healthcare cost2) could largely be avoided by doctors, nurses, caregivers and patients working together to increase medication adherence.

What is medication adherence?

Medication adherence simply means accurately taking your medications as prescribed. While this seems easy, it may surprise you to learn that over 50% of people are not taking their medications as prescribed! When people don’t follow these plans, they risk complications that could worsen their health. For a treatment to be effective, it’s extremely important for medication regimens to be followed.

The effects

The consequences of medication mismanagement are most significant in diseases where missing doses dramatically increases the likelihood of future complications. Cardiovascular disease, especially high blood pressure, is particularly worrisome because it is so common and the complications are so debilitating. Keeping blood pressure within the appropriate ranges significantly decreases the risk for stroke or ischemic heart disease1 and the only way to achieve this is by reliably sticking with a medication regimen.

Medication mismanagement is especially common with medications for cardiovascular disease. For example, evidence suggests 50% to 80% of patients treated for high blood pressure are non-adherent with their medications.4 Medication adherence tends to gradually decrease over a 2 year period after a medication is prescribed. Studies have shown that patients who discontinued their medications within 30 days of being prescribed had a 10 times greater mortality rate than those who continued their medications within a year.1


It’s easy to just place all the blame on the patient. After all, they’re the ones not taking their pills as prescribed, right? But the problem is much more complicated than that and can have many causes. Let’s dig into each of these a little bit more.

On the patient side, one of the biggest causes of mismanaged medications is health illiteracy.1 Simply stated, most patients do not know what medications they’re taking or why those specific medications have been prescribed to them. This lack of knowledge can lead to underestimating the importance of the different medications, making it easier to decide to stop without consulting a healthcare provider. Often, a patient notices a medication’s side effects but doesn’t feel any better, which can become frustrating. Pairing this frustration without knowing a medication’s long-term benefits often results in people choosing to stop taking their medications.

Physicians and other healthcare providers are responsible for ensuring the health literacy of their patients. This often does not happen due to a variety of reasons. Sometimes patients are not involved with the decision making process whatsoever as they struggle to find time to voice their concerns in a short clinic visit! This can be extremely frustrating for both the patient and the provider.

Another area of concern is complicated medication schedules. It has been shown that medication adherence decreases if pills need to be taken more frequently throughout the day. For example, if a patient takes pills once daily they are likely to be 80% adherent, twice daily: 70%, three times daily: 65%, and four times daily as low as 50%.3

A fragmented healthcare system also contributes to medication mismanagement. Often a patient will see many doctors, nurses and caregivers. Due to different technologies and business practices, a miscommunication between parties is likely. This can lead to complications like duplicate medications, missed refills or even completely unnecessary medications!

Our Solution

Adherence will suffer when patients lack education and the team of caregivers lacks communication. The ideal solution is one that can benefit and align the entire team. We are helping to ease this problem with Dose Flip, a simple to use smart pillbox.

Dose Flip assists patients in the home by automatically revealing their medications at the right time, minimizing the chance of dispensing the wrong pills. It empowers the patients to have independence and feel involved with their medications.

Dose Flip can assist nurses, caregivers and family members by informing them with a web portal or text and email notifications when medications have been dispensed or are about to be missed and notify when refills are needed. This helps to connect the caregiving team and remove communication challenges.

Dose Flip helps doctors provide better care by providing adherence data from the pillbox. They can see trends in how often pills are missed or dispensed late, and ideally adjust patients’ drug regimens to better optimize their schedules and improve their health.

By using Dose Flip, clients with dementia have consistently increased their adherence rates from below 60% to over 90%--a major success! This is a dramatic and powerful result that we can use to bring the caregiving team of doctors, nurses, and caregivers together to face this challenge of medication non-adherence. Together, we will decrease costs for patients and healthcare organizations. And most importantly, we will save lives.

1. Brown, Marie T., and Jennifer K. Bussell. "Medication adherence: WHO cares?." Mayo Clinic Proceedings. Vol. 86. No. 4. Elsevier, 2011.

2. "Medication Adherence - Taking Your Meds as Directed." Medication Adherence - Taking Your Meds as Directed. N.p., n.d. Web. 09 Nov. 2016.

3. Osterberg, Lars, and Terrence Blaschke. "Adherence to medication." New England Journal of Medicine 353.5 (2005): 487-497.

4. Costa, Francesco Vittorio. "Compliance with antihypertensive treatment." Clinical and experimental hypertension 18.3-4 (1996): 463-472.