The management of a relatively straightforward disease like hypertension requires multiple parties to work together to achieve a common goal of reducing a patient’s cardiovascular risk. The physician requires the necessary medical acumen to accurately diagnose hypertension and any underlying causes. But most importantly, it requires significant understanding and effort on the side of the patient. They need to remember when to take their drug and how much to take, which seems simple when your only diagnosed disease is hypertension.
But consider the average patient I see as a medical student: A 65 year old man with diabetes, congestive heart failure, hypertension, kidney disease, peripheral artery disease, and no consistent mode of transportation to pick up his medications at the pharmacy. For each of these conditions they are on multiple medications, some taken at night and some in the morning. Some with food and some on an empty stomach. Many of these patients have some aspect of cognitive dysfunction as well, making their daily medication regimen nearly impossible without some help.
As described in the journal of clinical hypertension, the elderly are particularly susceptible to medication compliance problems.
“It should be remembered that polypharmacy is more of a problem in the elderly, who frequently have several disease processes requiring treatment. Single-drug combination therapy is often useful. Pill splitting may be difficult for elderly patients and should be discouraged. Visual impairment in the elderly may also be important in drug compliance.”
Unfortunately, much of the treatment of hypertension, or any other disease, is largely out of the control of the physician once the patient leaves the office. Luckily a company called PillPack has come up with a beautifully elegant solution to this problem. They have a subscription service for just $20 per month that will send you a tear-away roll of individualized packets filled with certain pills for each time of the day. No more need for arcane pill boxes. No need to read the small print on the side of the pillbox. Just tear away your pack, and take the enclosed capsules. They ship your medications straight to your door and even contact the doctor directly for refills.
What a brilliant idea and another great example of how fantastic medicine can be when agile start up companies offer solutions to the real problems facing healthcare today.