Using Intelligent Agents to Drive Adherence

Kevin AppelbaumCo-founder & CEO

Medication non-adherence is a challenge, especially among patients with chronic disease. When patients fail to take medications as prescribed, for example they miss a dose or end a regimen early, consequences can range from insignificant to life threatening. Nonadherence can lead to misdiagnosis, improper treatment and hospitalization, and is estimated to cost the U.S. healthcare system at least $100 billion annually. With nearly 60% of adults taking a prescription medication, significant resources have been invested to develop solutions, yet the World Health Organization estimates medication adherence is only about 50%.

Research shows a handful of underlying causes. While some patients report forgetting and accidentally missing doses, numerous studies have found that many patients deliberately skip or stop medication because of negative side effects and/or inconvenience. Non-adherence is not simply about a patient’s poor memory; the medication itself is often the deterrent.

Better Therapeutics is developing non-drug alternatives for treating lifestyle-related disease, and employing a two-pronged approach to maximizing adherence. First, our digital program delivers lifestyle as medicine where all the side effects are good ones. Disease can be reversed, medications reduced, and people feel better. It’s a medication people want to adhere to.

"The best thing I have noticed so far is my blood pressure has gone down - I feel good and am excited to show my doctor my good readings. I have more energy, less tired, and not dragging all the time. I love the accountability, praise and reinforcement." Better participant, Arkansas, week 3

Second, in digitally-delivered therapies like ours, engagement is arguably the equivalent of medication adherence. In clinical trials we have demonstrated that higher digital engagement is correlated with better clinical outcomes; in this case, reduction in A1c in adults with type 2 diabetes. These findings and others were peer-reviewed and published in a medical journal earlier this year.

engagement hba1c

We recently deployed an artificially intelligent agent or “chatbot” to drive adherence by engaging with patients in a way that is as familiar as texting a friend. Known to patients as Cassie, the agent uses contextual data to tailor messages to the individual, and has the capacity to adjust messages using machine-learned algorithms in concert with real-time patient interactions.

We measured engagement during two comparable periods - the last six weeks of our clinical studies in diabetes and hypertension. The diabetes study did not include the use of a chatbot, while the hypertension study did. We found that the integration of a chatbot more than doubled engagement; from 3.5 actions per day during the diabetes study, to 8.3 per day during the hypertension study, thus increasing adherence to our prescription of lifestyle as medicine.1

Chatbot - adherence

We are excited by these early indications that artificially intelligent agents may offer new solutions for increasing adherence to therapy. At Better, we are building on these early experiments in order to maximize clinical outcomes by using technology to drive ‘whole patient’ adherence to both our new, behavioral therapies, as well as pre existing medical treatments. We are optimistic that through our innovations, as well as those of others, we may be able to arrest the epidemic of chronic disease, and reduce or eliminate the patient need for lifelong medications and associated costs.

1Results from our hypertension study will be published this summer.

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