A Small Tool with a Big Impact

Sometimes the simplest things can make a dramatic difference in medicine.  Internist Adriana Andrade, M.D., found that out recently when she tested a portable medication-reminder device for AIDS patients.  The finding?  The pocket-size gadget can, within half a year, lead to a significant, 10-fold drop in the amount of virus HIV patients carry in their blood or spinal fluid.

“This is an impressive decline for such a relatively simple technique,” says Andrade, a clinical pharmacology fellow in the Department of Medicine.  Also, CD4 cells increased by 50 cells per milliliter of blood in patients with the device, but only by a fifth of that in those without it.

The device, called DMAS for Disease Management Assistance System, is designed to verbally remind patients burdened with a complex regimen of medications when to take their pills and what side effects to watch out for.  The system has proved especially helpful for a subgroup of AIDS patients with mild-to-moderate memory problems brought on by the disease.  In a six-month study, patients on DMAS stuck with their therapy, on average, 11 percent more often than those who heard a monthly half-hour pep talk on how and why to use their medications.  Many of the DMAS patients had compliance ratings of 90 percent or higher.

“Most who use this system say they find it extremely helpful,” Andrade says.  “It adds some structure to their therapy; something that frees them to focus on other things.”

The device works by beeping and flashing when it’s time for medicine.  Patients press a “play” button, prompting a voice that instructs them to take a particular drug.  Patients then push a second button to confirm they’ve taken the medicine.  Forget any of these steps and DMAS beeps periodically for up to three hours.

The system also quizzes patients on quality of life issues, measures neuro-cognitive deficits due to HIV, and adds messages about possible side effects or how to offset them.