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Post by Admin on Nov 15, 2017 13:21:19 GMT -4
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Post by muqaddam on Nov 15, 2017 17:36:58 GMT -4
Dr. Antin and I just spoke about this FDA approval yesterday. I agree with this use of technology because it indeed can help those that forget to take their medication or those that must take their medication but do not, and hopefully can save money in the long run from costly consequences that unravel with noncompliance. One thought that came to mind was how would they get the patient who does not want to take their meds give them permission for the use of this digital pill? Things we have to keep in mind are the following: it can take 30 minutes to 2 hours to detect ingestion of the tablet; sometimes the system might not detect that the medication was actually taken. This can lead to many problems, mistrust and confusion. All in all, it's a "cool new thing" and until we test it out, we won't know for sure how great or bad it really is. Lastly, it's wonderful that this digital pill can help those who forget to take their meds to remember, but it means nothing if they forget to change the freaking 7 day patch on their left rib.
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Post by Terry K Tran on Nov 15, 2017 20:51:53 GMT -4
When I read the title of this article, I thought of a few pros and cons that were mentioned in the article. The positive side of using digital medication is clearly evident for patients who are prescribed a menu of drugs that must be taken at specific time. As the article mentioned, perhaps implementing such modality as a parole condition for patients with psychiatric conditions with criminal offense. This would most likely increase adherence and prevent relapses of symptoms. However, I can understand Dr. Peter Kramer's point of view, of how it might become a coercive tool. The possibility of abusive use cannot be overlooked. But then again, if it's done with informed consent it might help decrease the chance of being misuse.
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Post by M Meyer on Nov 18, 2017 22:48:39 GMT -4
I think it is a really cool idea, but it seems kind of elaborate for the benefit. I guess I don't get the point exactly. It confirms the patient is taking the meds, which is good, but say a patient goes off their meds what is the plan, force them to take the medication, or call them and tell them to take it, just document it in the note? It just seems like a lot of technology and effort for an unidentified plan. The article suggests the electronic pill is “especially for patients who just experienced their first psychotic episode and are at risk of stopping medication after feeling better.” So once the pill is not taken, are these people going to be forced to take the pill or just called. If the answer is a call, then the doctor calls and the patient will either change their mind or they won't, so I guess it remains to be seen if a large enough percentage of patients change their minds and take the pill, to make it worth the cost. Also I think liability comes into play as well, once this sensor is used then it seems like fault may be shifted if the patient does not take their medication, for example if a patient does not take their meds and the doctor knows but does not call the patient within a day or two, and the patient hurts someone or themselves, does that become the doctors fault? I like the idea for clinical studies because it helps to reduce error. I also think it would be good for people who feel they want a reminder if they forget, and their phone will remind them if it does not sense the pill was taken. But I don't know that is it the solution for psych patients who don't want to take their medication.
I also feel the information could be used against patients. For example if the patient does not use the medication as directed, then it gives the insurance company ammunition to fight paying for the medication in the future. Insurance companies can force patients to take it in this form by only offering to pay for the electronic pill version. In all I think this could be really helpful in some ways but has potential to be used against people.
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Post by Ize Anumah on Nov 21, 2017 15:19:12 GMT -4
When you think of patients who do not take their medications regularly and for that reason are a danger to both themselves and the society then the idea of digital pills may appear appealing that is if the provider with access to the information has a plan in place to enforce compliance because otherwise the information may be somewhat useless. However since there are other ways to handle non compliance in patients, such as IM shots for schizophrenic patients, the importance of this digital pills for this class of patients becomes questionable.Therefore the pills would only be valuable if the provider has a plan of enforcement in cases of non compliance and if there are no already existing easier methods to ensure compliance. One way it could particularly be useful is in determining who requires hospitalization to be compliant.For example in TB patients, a doctor could ascertain which patient needs to be kept in the hospital and which ones can be trusted with thier medications to be taken from home without supervision. If a patient starts off as fine without supervision and slacks off along the way, because he would be a danger to the community, the doctor would be aware and determine if a problem that can be solved caused the non compliance or if the patient needs to be hospitalized and supervised.It could also be used in elderly patients who may be non compliant due to forgetfulness especially those living alone. The sensor could be connected to relatives the patient consents to and they could remind the patient when they notice they haven't taken their medications.it makes it easier for relatives to monitor compliance when they cannot physically be present for that. However the issue of trust in the physician patient relationship is a serious one to consider. But if the patients consent is needed to administer the digital pills then that may not constitute much of a problem. The issue arises when the patients who need the most to be monitored are the most likely to withold consent. Schizophrenic patients who already experience hallucinations, delusions would most likely not consent to being 'pill monitored'. However, it is interesting to see where this takes us and how it would be received by the patient population.
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Post by robin chowdhury on Nov 25, 2017 18:11:02 GMT -4
While this pill may be beneficial to make sure patients are compliant with their medications, it does not seem like it makes that big of a difference. The fact that the patient can grant permission to who can see whether they are taking their medication defeats the purpose of this sensor pill. For example if there is a postop patient who is taking opioids, they can take more than they should be taking and hide it from their physician if they are given this pill (assuming it applies to other medications other than Abilify). The freedom given with the pill is the concern here because they can block whoever can see if they are taking their pill whenever they want.
Also the idea that these are given to patients with mental illnesses like Schizophrenia is odd, because it can make them even more delusional considering that they might think there is a device in their body that people can be tracking!
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Post by Jennifer Joshua on Nov 25, 2017 19:59:17 GMT -4
This article highlighted two important problems patients face when it comes to their treatment and their willingness to comply with medications. The idea of having a digital system of monitoring whether patients are taking their medication sounds like an excellent idea in monitoring the progress of patient. For example, when a patient is on medication – say Abilify, and their symptoms are not improving, the question is now firstly, are they taking the medication? Or secondly is the medication just not effective. In this case a digital pill will help answer the question. Because it will show and keep record of whether they have been compliant. And from my observation compliance plays a big role in pysch patients. As some of them experience undesired side effects. On the other hand, most pysch patients who are paranoid, might and will be unwilling to have a system that monitors their medication intake. In my opinion, patient education will still be necessary as to the importance of their compliance with their medication. Whether they choose to go the digital route or not
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Post by Ify Nzenwa on Nov 25, 2017 23:10:52 GMT -4
Like many subjects in medicine, the Digital sensor pill comes with numerous pros as well as cons. A big pro that was mentioned was that it can potentially help those that don’t remember to take their pills or need extra incentive such as copay reduction to help them become more compliant with their medications. However, in my opinion the pros only seem feasible in theory. For instance, there would have to be an internal need from the patient to become more compliant with the medication. If the patient is exhibiting noncompliance due to the fact that they feel they are fine or paranoid that the medication is used to control them… the sensor will not be effective because the patient will have a bigger incentive not to take the medication and may cause greater harm being that the patient may stop going to follow-up consultations. I do see the practicality of the sensor and see the importance of a clinical trial to assess the effectiveness of the sensor.
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Post by Faithful Ogundiran on Nov 27, 2017 0:18:14 GMT -4
I think that there are pros and cons to this recent development. I'll start with the pros: this technology would go a long way in helping doctors track their patients use of prescribed medication, it would also help to determine effectiveness of such medication, it helps to determine if its the patients fault or that the medication just does not work for that particular patient. On the patient's part, it helps patients to be more compliant especially when they know their doctor can actually track how well they take their medication. It could also be a form of record especially for patients who love to pen down every medication they have ever taken. It could also serve as a reminder to patients who forget to take their medication. On the other hand, the cons: I think this would mean invading patient's privacy because some patients may feel like "they are watching me" and defeat the purpose of the medication in the case of patients with a mood disorder. Some patients may think that "the doctor doesn't trust that I'll take my medication" and that could destroy patient-doctor relationship when patients think that the doctor doesn't trust them. As much as the pros seem to outweigh the cons I would suggest that the use of Digital pill should be carefully considered before enforcing it.
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Post by Rita Rehana on Nov 28, 2017 22:41:38 GMT -4
A few pros and cons came across my mind after reading this article. One pro would be that doctors can appropriately medically manage their patients as their compliance can be monitored adequately; this will improve patient care and treatment overall. The advances in medicine has shown here that it can extend beyond the psychopharmacological realm of medicine and it can benefit other medical causes, possibly beyond treatment and furthermore maintenance. As mentioned in the article, the costs of hospitalizations and exacerbations of other medical issues, underlying or organic, will be substantially decreased since the patient will be compliant with medications therefore causing less problems for the patient and more cost effective for the hospitals/administrations. Some cons that were contemplated through this read were the fact that a pill with a "tracking" feature for a person of mental health issues, such as schizophrenia and bipolar disorder, can be a little bit challenging; especially since these patients exhibit symptoms of paranoia and delusions. The other downfall was the receptor patch that needs to be changed every 7 days...since compliance is already an issue, I can see the changing of the patch becoming a compliance issue as well. Nowadays, insurance companies vary with their coverage, and the cost of something like this digital pill device, I assume it is very expensive and I can see that cost would be an issue. Some of the main reasons why patients have compliance issues are that they cannot afford the medications, access to a pharmacy or transport availability is limited or obsolete, and side effects. Fortunately, there are facilitators like the ACT team which is available to those who need it, especially patients without any social support; they're advocates to patients with mental health illnesses.
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Post by Harsh Patel on Nov 29, 2017 19:53:47 GMT -4
I am not entirely sure how beneficial this particular technology will be in overall patient health. While the pros would be obvious in the sense that doctors will be better able to track patient compliance and in return efficacy of that particular treatment in that particular patient, I personally feel as though it will have more of an adverse effect on patient compliance. This is particularly true for a psych patient with Schizophrenia who might be paranoid. While a lot of psychiatry is based on creating a rapport with the patient and a trusting environment, having a tracker in their pills might not be the best way to do that. I can see the first reaction being "you don't trust me to take my pills doc?" At the end of the day, most doctors are able to tell compliance level of their patients by their personal history with them. Knowing the exact level of compliance or non compliance isn't necessarily going to change the management. This tracking technology will probably be more useful in a very niche population with memory problems perhaps or in other specialties such as pain management and dispensing of controlled drugs.
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Post by Jade Alfasi on Nov 30, 2017 0:09:00 GMT -4
For every action in nature there is an equal and opposite reaction. The pill could be made with the intent of saving money but there will always be unintentional actions as a side effect. To say $100 billion is estimated lost by misuse of drugs can be true, but it's impossible to say that all of that money will be saved for certain. The advancement of technology is often met with great resistance due to the increased amount of monitoring we face as citizens today. I believe some people might enjoy the idea of a more efficient system of monitoring but overall people will be unhappy about the increased amount of "big brother". The limitation in the potential market for the monitoring system will increase the costs of using such a system as well. People do not need it for basic antibiotics or for cough syrup. It would only benefit patients who already have a certain degree of medical problems and stands the potential to increase the costs of the already expensive care they receive.
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Post by Ukpono Inyangudoh on Nov 30, 2017 12:33:07 GMT -4
While the idea of a digital pills might be a good idea in saving billion of dollars every year it also has its downsides especially since one of the first experimentation is on schizophrenic patients. In the aspect of research it is a beneficial concept because it's easier to see if participants are taking medication as they are supposed to. It will also be good for the protection of the general populace, as stated above compliance in TB patients can be monitored and only non infectious patients are discharged. But the down side is it takes away alot of patients privacy, can cause paranoia in schizophrenic patients and mistrust among patients and doctors and even their family members who have assess to this apps. In conclusion having a digital pill with no plan of action when patients are not compliant makes the whole program futile. In other words "Who wants a smart pill in their body?. I know I don't."
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Post by Onyeka Olisemeka on Dec 1, 2017 13:08:28 GMT -4
While I entirely agree with everyone's sentiments on the matter, I think a few things stood out to me. It is understandable that the intention of the technological advancement was to improve compliance with medication regimens and to act as a form of digital accountability to the patient, their family and the healthcare provider. And as has been pointed out previously, it is extremely problematic to start the trial of this medication with Abilify, an antipsychotic medication geared towards treating schizophrenia, bipolar disorder and other such conditions. This is because patients that the medication is geared towards are the ones who are the least likely to actually consent to it. For those who do consent, the concept of a patch and pill that monitors their adherence is something that would most likely trigger their paranoia, especially in those with delusions. I do not feel that this should be too much of a concern as the article did state that the digital pill will only be used in patients who the doctor felt was capable of benefitting from it and were sound enough to be able to manage the app and the requirement that go along with it. In addition, it said that many psychiatrists would likely want to try digital Abilify, especially for patients who just experienced their first psychotic episode and are at risk of stopping medication after feeling better. Besides, the medication trials have started for other medications as well, including those that treat HIV, diabetes and heart problems. All that to say that the digital pill should not be judged on what it DOES but rather for what it IS.
For what it IS, the digital technology is quite awesome. It allows for doctors to be able to tell when patients have been adherent or when they haven't. This eliminates the guesswork of whether the medication is not effective for that patient, or if it just wasn't administered appropriately. While it is geared towards improving compliance in patients who often forget to take a dose, a major drawback would be the only 25% of the causes of non-compliance is due to forgetting, while the other 75% have nothing to do with forgetfulness. This technology can make a huge dent in those numbers, but cannot serve alone to improve compliance as other factors such as "perceived" harm, miseducation about side effects, actual side effects and medication costs combined ranked higher than forgetfulness alone (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934668/).
Ultimately, this is a step in the right direction but is in no way the solution.
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Post by RC Sabooree on Dec 3, 2017 21:55:16 GMT -4
Every new invention comes with its own cons and pros. Yet, as an individual who has worked at few different emergency rooms and pain management centers, all I can tell is that, the benefits of such invention are a lot more than that of its shortcomings. Followings are some of the reasons why I believe such invention was required for the medical industry: • Utilization of digital pill would make it impossible for the fakers to come back for more medications. I have seen many people who fake their symptoms to get medications and sell them afterward • It would make it easier for the doctors to control their elderly patients, or the patients with dementia. • This would also make it easier for the police to evaluate the mental condition of the individuals involved in severe accidents • It would make it possible for the provider to treat patients who are admitted as a result of suicide by OD
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