PHARMACY

BY: Stadtlanders Pharmacy Adherence Team

Given the complexity of HIV/AIDS drug regimens and the sheer number of medications that must be taken daily, it's not surprising that missed doses of medications can be an issue. If you have a problem with missed doses, the first step is to identify the specific reasons or barriers that prevent you from taking all your medications. Barriers to adherence may include such things as lack of information, side effects, and issues that are organizational (forgetfulness, trouble co-ordinating medications with your lifestyle), financial, and psychosocial (e.g., depression, substance abuse, housing difficulties). Many people who have every intention of taking their medications on time simply get busy with their daily activities and forget. If this is the case for you, the use of a simple adherence device may help you organize and manage your medications.

Medication organizers (pillboxes) are easy to use, inexpensive, and available in many different sizes and styles. They range from pillboxes that hold a single dose to boxes that hold a week's worth of medications. A seven-day pillbox with removable daily compartments can be especially helpful. It allows you to organize your medications for the entire week and to carry the current day's supply with you. If you have trouble remembering whether you took a dose, simply check to see if the pillbox compartment is empty. A "marker" (e.g., a button or a piece of candy or paper) can be used to remind you of any medications that can't be stored in the pillbox such as medications requiring refrigeration or storage in the original container.

A timer device (e.g., a wristwatch alarm, a pillbox with an alarm, or a computer alarm) is an option if you have trouble remembering to take doses on time. Pillbox timers that sound an alarm when a dose is due and have a compartment to hold one or two doses are especially helpful when you're away from home. This type of device also serves as a visual reminder of whether or not the dose was taken since you can check to see if the compartment is empty. The ALRª (A Little Reminder), a small, triangular-shaped device that fits on a key chain and beeps or flashes when it is time to take your medications, can help people who experience forgetfulness or who have trouble co-ordinating medications with their daily schedules.* Currently, the ALR needs to be programmed at your pharmacy or doctor's office, but a new version of the device that will allow you to set the alarm yourself may soon be available.

As paging devices and cellular phones become more popular, it is likely that they will be used with increasing frequency as medication-reminder tools. Also, a number of companies are offering medication-reminder services. Some online services (e.g., the one available at <www.medimom.com>) provide a user-friendly Internet site where you can set up and modify your own messages at any time. Although cost can limit access to such services for some, they are becoming more affordable. Other impressive high-tech devices are being developed and tested, but currently their size, complexity, and/or expense limit their usefulness.

These devices are designed to assist people whose adherence problems can be addressed by better organizing and managing their medications. Obviously, such devices are not a solution for everyone. Some people would receive greater benefit from education about their therapy or from financial or psychosocial assistance. Speaking honestly with your healthcare providers about the barriers that affect your medication adherence is the first step.

* Stadtlanders Pharmacy and the Jewish Board of Family and Children's Services in Brooklyn, New York conducted a collaborative study of 63 adults with HIV/AIDS to assess the ALR device. The Jewish Board is a progressive Adult Day Health Care Services Program that provides care for individuals living with HIV/AIDS. The number of clients completing the pilot was small, but clients with organizational problems (e.g., forgetfulness, medication/ lifestyle conflicts) demonstrated improvement in medication adherence using the ALR.