Patent Publication Number: US-2007097792-A1

Title: System of increasing outpatient medication compliance using reminder devices attached to containers at point of filing and associated methods

Description:
CROSS REFERENCE TO RELATED CO-PENDING APPLICATIONS  
      This application claims the benefit of, and expressly incorporates herein by reference, the entire disclosures of the following U.S. patent applications: 
          U.S. patent application No. ______ (SP-100), entitled SYSTEM OF INCREASING OUTPATIENT MEDICATION COMPLIANCE USING ELECTRONICALLY ENHANCED CONTAINER AND ASSOCIATED METHODS, filed Nov. 2, 2005, which in turn claims priority to U.S. Patent Application No. 60/624,433, entitled SYSTEM OF INCREASING OUTPATIENT MEDICATION COMPLIANCE USING ELECTRONICALLY ENHANCED CONTAINER AND ASSOCIATED METHODS, filed Nov. 2, 2004;       

    
    
     FIELD OF THE INVENTION  
      The present invention relates to improving health care, specifically to reducing patients&#39; lifetime health care cost and improving patients&#39; quality of life by increasing outpatient medication compliance with dosing regimens.  
     BACKGROUND OF THE INVENTION  
      Outpatient prescription medication treatments are relied upon so heavily for increased quality of life and lower lifetime healthcare costs that $307 billion is spent each year globally for such medication; more than half, or $160 billion, is spent in the U.S. alone, according to IMS Health.  
      The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Medication Compliance Special Interest Group (Med Comp) states as its objective “To stimulate research and evaluation on issues related to medication compliance, treatment persistence, and implications for health outcomes.” ISPOR Med Comp defines medication compliance/adherence as “the extent to which a patient acts in accordance with the prescribed interval and dose of a treatment regimen, measured by percentage of doses taken properly.” ISPOR defines medication persistence as “the accumulation of time from initiation to discontinuation of medication therapy, measured in time.” 
      Medical experts have long held that taking at least 80% of a prescribed drug is required to achieve desired therapeutic outcomes and lower lifetime healthcare costs. For example, a patient who faithfully takes cholesterol-reducing medicine significantly reduces the likelihood of a coronary event with attendant cost-intensive medical procedures and diminished quality of life. Outpatients strongly desire to avoid such events and hospital stays, yet only 20% of all outpatients take their prescription medicines according to doctor&#39;s instructions. Four out of five do not, as documented by the Healthcare Compliance Packaging Council Task Force Report of 1993. That report and other industry sources calculate average patient compliance with prescription-medicine dosing regimens at 50%. It further documents that 15% of patients don&#39;t even fill prescriptions, 14% fill prescriptions but don&#39;t take any doses, 22% take less than prescribed, and 29% stop before finishing the prescription.  
      In consequence are otherwise unnecessary hospital admissions at a cost of between $31 billion and $100 billion annually, estimated by the Schering Report IX called “The Forgetful Patient: The High Cost of Improper Patient Compliance” and MedAdvisor, Inc., respectively. According to studies referenced in Compliance  Packaging: A Patient Education Tool  (D. Smith, American Pharmacy, Vol. NS29, No. 2 February 1989) medication non-compliance causes 125,000 deaths annually.  
      The economic impact of non-compliance is large and increasing. L. R. Standberg reports in  Drugs as a Reason for Nursing Home Admissions  (American Health Care Association Journal, 10,20 (1984)) that 23% of nursing home admissions are due to medication non-compliance. The cost was estimated at $31.3 billion/380,000 patients. In the Oregon Department of Human Resources publication,  A Study of Long-Tern Care in Oregon with Emphasis on the Elderly  (March 1981), it was reported that 10% of all hospital admissions where due to medication non-compliance. With the aging population in the United States, it is reasonable to expect that this problem will only get worse.  
      Pharmaceutical manufacturers also stand to gain from increased outpatient medication compliance in the form of increased medication sales. Accordingly, these manufacturers are actively investing in and testing compliance-increase techniques. A marketing executive at one major Pharma company said that his market research documented that patients want to comply, but will not take on the burden of any additional actions or otherwise change behavior. To help determine which mechanisms were successful in increasing patient compliance, this executive also said he&#39;d pay $10 per months for each of 10,000 patients&#39; dosing data. Pharmaceutical manufacturers GlaxoSmithkline, AstraZeneca, Bristol Myers-Squibb, and Lilly were among 11 pharmaceutical companies with director/manager-level delegates attending Center for Business Intelligence&#39;s “First Ever Forum on Patient Compliance,” Apr. 11 &amp; 12, 2002 in Philadelphia. CBI&#39;s “Third Annual Forum on Patient Compliance and Persistency” was held with a larger group Apr. 19 &amp; 20, 2004.  
      At the 2002 Forum on Patient Compliance, Robin Lugar, MSW, ACSW, Ph.D. candidate at Indiana State University, presented findings of her patient-compliance literature compilation and analysis from 1974 to 2000 in which she identified 11 discrete theories and drew four salient conclusions. Conclusion one: “There is no consistent theoretical model for prediction of non-compliance.” Conclusion two: “Subjective measures of patient and physician report overestimate compliance.” Conclusion three: “Medication taking was based on how well the regimen fit into daily life.” Conclusion four: “Because of lack of consistency in research findings, it might be fruitful to investigate several factors simultaneously.” 
      As to factors causing non-compliance, authors of  Facilitating Treatment Adherence,  Donald Meichenbaum of the University of Waterloo, Ontario, and Dennis C. Turk, University of Pittsburgh School of Medicine, cited a compliance study published in 1978 by Epstein &amp; Masek in which 193 factors affecting patient compliance were examined at least 10 times. Four of the 193 factors had direct correlation with compliance level in more than half the studies: patient satisfaction with treatment results, long-term (chronic) therapy, paucity of information from doctors, and burdening patients to change behaviors.  
      Even so, a number of current compliance-improvement techniques rely on changing patient behavior, e.g., HealthMedia, ScriptAssist, Epotech, and Xceleron. All relied on reminders via postal mail or telephone to encourage patients to increase compliance. Affirming Epstein &amp; Masek&#39;s 1978 findings, Ohio State University professor of emergency medicine, Robert Guthrie, concluded in 2003 from a study of 4,548 patients that such behavior-change tactics don&#39;t work. The study, sponsored by Bristol Myers-Squibb and published in the summer 2003 journal of Clinical Therapeutics, caused Dr. Guthrie to conclude that “According to patients, the telephone and postal reminders did very little to improve their compliance,” he said. “Health care providers, third-party payers, and health care policy-makers should take note that these costly extra measures to ensure compliance don&#39;t appear to have an effect.” 
      In fact, such reminders have been known to backfire. In July 2005, a director in clinical trials at GlaxoSmithKline cited a study he knew of in which these reminders annoyed patients to the degree that they intentionally did not take their medications as directed.  
      However, electronic packages have proven effective. In one 1992 study with an anti-hypertensive treatment, control group compliance was the expected 50% while the test group was 92% compliant via use of an electronic packaging device, called PreScript TimeCap. In the 70-patient study by Jackson T. Wright Jr., M.D., Ph.D. et al., called  Impact of an Electronic Medication Compliance Aid on Long - Term Blood Pressure Control  (Journal of Clinical Pharmacology, 1992:32:277-283) the authors cited the electronic package as increasing compliance, then in turn cited the increased compliance as improving the therapeutic outcome, in stating that “The most impressive finding was the clinically significant lowering of blood pressure.” 
      In a focus group evaluation of an electronic-reminder medication package, four cardiologists with Cardiovascular Healthcare Consultants, P.C. of Paoli, Pa. in November 2001 said that medication compliance is so important that, among two or three equivalent drugs, they would specify the drug whose package fosters higher patient compliance. The example given was three competing cholesterol-lowering medications. It&#39;s well known by cardiologists and their patients that cardiovascular disease is the leading cause of death in the Western world.  
      Numerous other packaging devices and adjuncts have been available for many years ranging from inexpensive tablet boxes with a compartment for each day of the week, into which patients may decant meds from pharmacy containers, to expensive Aprex electronic reminder/monitoring devices. In the study  Microelctronic Systems for Monitoring and Enhancing Patient Compliance with Medication Regimens  (Cramer, J. A, Drugs, 49: 321-7 (1995)) the author concludes that patients are simply unaware of their own level of medication compliance, making changes in behavior difficult. “Many people who take medications long term have neither any concept of how poorly they comply nor thoughts about how to enhance compliance by developing special tactics to remember dose times,” Cramer says. “The potential gains in improved self-care of individual patients are well worth the cost of monitoring devices.” 
      Irrespective of cost, no device has gained wide acceptance because all rely on changing patient behavior to suit the medication, whether in the form of decanting or remembering to push an event button to reset electronics, rather than changing medication conveyance to suit patients. What is needed is a mechanism which requires no additional action of or cost to patients to improve their compliance by incorporating reminder apparatus and its programming in the medicine supply chain.  
      It is therefore an object of this invention to provide a system for and methods of increasing medication compliance in a manner that outpatients prefer, i.e. with no need to change their behavior or spend more of their money.  
      It is a further object of this invention to provide a system for and methods of incorporating integral reminder apparatus in the medication supply chain.  
      It is a further object of this invention to continually increase patients&#39; compliance with medication dosing regimens by optimizing type of reminder signal for specific patient segments based on compliance data collected from returned containers.  
      Further objects and advantages of this invention will become apparent from the figures and related description.  
     SUMMARY OF THE INVENTION  
      The present invention is a method of continuously increasing patient compliance with medication dosing regimen that does not rely on incremental effort, investment, and/or other patient resource. The method includes uploading compliance data from one or more electronically enhanced containers to a database, analyzing said uploaded compliance data, generating one or more patient specific compliance reports from said database, and reporting said one or more patient specific compliance reports to one or more stakeholders. The compliance data may include one of the following: frequency, date or time of daily dose dispensing. The analysis may also include one of the following: level of patient compliance, effectiveness of a specific reminder type; and the analysis may result in a recommendation for a specific type of the reminder type. The reminder types may include one or more or, a combination of the following: audible, visual, or tactile. Compliance data is preferably accumulated in a compliance data registry; where the compliance data registry may include one or more of the following: treatment outcomes relative to compliance, or data on effectiveness of reminder type for various patients. The stakeholders may include one or more of the following: a Patient, a Medical Professional, a Health Insurance Company, a Pharmaceutical Manufacturers, a Caregiver, or a Hospital. The patient specific compliance reports may include one or more of the following: patient name, medication name, doctor&#39;s name, report date, reminder time, date and time of container opening and closing, double dose attempts, percent compliance.  
      The invention further includes a method of measuring return on investment in increasing patient compliance using compliance reminder signaling devices and related methods, and/or other reminder methods. The method includes generating a patient specific compliance report, reporting the patient specific compliance report to one or more stakeholders, determining if patient compliance increase target has been achieved, optimizing type of the reminder signal device if the patient compliance increase target has not been achieved, and documenting return on increased compliance. The Pharmaceutical Manufacturer preferably analyzes the patient compliance report to inform decisions regarding financial investments into increasing patient compliance. Determining if patient compliance increase target has been achieved includes seeing whether the anticipated compliance increase achieves a specific target increase. Optimizing type of the reminder signal device may include analyzing the patient specific compliance report for effectiveness of different types of the reminder signal devices for various patient group lifestyles, and adjusting the reminder type to the patient group lifestyle. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       FIG. 1  shows a conventional medication dispensing and monitoring system.  
       FIG. 2  shows a conventional medication dispensing and monitoring system using a programmed reminder device.  
       FIG. 3  illustrates a system for increasing outpatient patient compliance with a dosing regimen.  
       FIG. 4  shows a method for increasing patient compliance with a dosing regimen.  
       FIG. 5  shows a method for medication distribution.  
       FIG. 6  shows details of a method for increasing patient compliance to a dosing regimen.  
       FIG. 7  shows a method of determining the level of patient compliance with a dosing regimen.  
       FIG. 8  shows a method of determining return on investment in compliance reminder signaling devices and methods.  
       FIG. 9  shows a sample report on an individual&#39;s compliance with medication dosing regimen.  
       FIG. 10  shows the sample report of  FIG. 9  with illustrative data.  
    
    
     DETAILED DESCRIPTION OF THE INVENTION  
       FIG. 1  illustrates Method  100 , which describes a conventional medication dispensing and monitoring process and includes the following steps:  
      Step  110  Packaging medication in bulk containers and unit-of use containers at a manufacturing site.  
      In Step  110 , medication is packaged at the manufacturer in bulk containers (usually 90 to 5,000 tablets or capsules) and in some cases, unit-of-use containers, usually one month&#39;s supply, for shipment to distributors, pharmacy benefit managers (PBM&#39;s) and re-packagers. Method  100  proceeds to Step  120 .  
      Step  120  Shipping bulk containers and unit-of-use containers to distributors, PBM&#39;s and re-packagers  
      In Step  120 , medication in bulk containers and in unit-of-use containers is shipped to distributors, PBM&#39;s, and re-packagers. Method  100  proceeds to Step  130 .  
      Step  130  Packaging Medication for Shipment to Dispensing Entity  
      In Step  130 , distributors, PBM&#39;s, and re-packagers may re-package from bulk containers into smaller containers, including unit-of-use containers, to fill specific dispensing entity orders. Method  100  proceeds to Step  140 .  
      Step  140  Shipping Containers to Dispensing Entity  
      In Step  140 , re-packaged containers and manufacturer-packaged containers are shipped to the dispensing entity e.g. a pharmacy chain. Method  100  proceeds to Step  150 .  
      Step  150  Dispensing Unit-of-use Containers or Decanting Medication from Bulk Containers into Patient-specific Containers  
      In Step  150 , Dispensing entity personnel dispense unit-of-use either from unit-of-use containers filled upstream, if available, or by decanting from larger containers into a container specific to the patient&#39;s dosing regimen, usually once daily in a unit-of-use container. Method  100  proceeds to Step  160 .  
      Step  160  Printing patient-specific-dosage instructions.  
      In Step  160 , dispensing entity automatically or manually prints patient-specific dosage instructions on a label suitable for attachment to the container specific to the patient&#39;s dosing regimen. Method  100  proceeds to Step  170 .  
      Step  170  Attaching dosage instructions to patient-specific containers  
      In Step  170 , dispensing entity personnel attach the printed label produced in Step  170  to the container specific to the patient&#39;s dosing regimen. Method  100  proceeds to Step  180 .  
      Step  180  Dispensing medication to patient  
      In Step  180 , the filled, labeled container from Step  170  is dispensed to the patient; in some cases, such as PBM&#39;s, dispensing is via mail or other shipment method. Method  100  proceeds to Step  190 .  
      Step  190  Monitoring patient compliance through refill frequency.  
      In Step  190 , patient compliance to the dosage regimen may be determined indirectly through frequency of refills. Method  100  ends.  
      Attempts to date to increase patient compliance have involved attaching dosage-reminder devices to containers by pharmacists, patients, or patient&#39;s caregivers. These have had no perceivable impact on compliance, principally because such devices increase, rather than lessen, patients&#39; burden in taking medication. These devices rely on patients for programming, record keeping, decanting, or pressing and event button. While variations of such devices have been around for many years, pharmacists have not been rewarded for taking the time to program and attach them and patients have not been willing to pay for and/or otherwise adopt them.  
      Further, pharmaceutical manufacturers have not endorsed reminder caps owing to hazards and related liabilities arising from a patient inadvertently replacing such a cap on the wrong container of different medicine with a different dosing regimen.  
      Method  200  in  FIG. 2  describes a novel process for adding and programming dose-time reminder apparatus to containers of method  100  at various points of container filling in the supply chain, beginning at pharmaceutical manufacturers&#39; container-filling lines. And includes to following steps:  
      Step  210  Packaging Medication in Bulk Containers and Unit-of Use Containers at Manufacturing Site.  
      In Step  210 , medication is packaged at the manufacturer in bulk containers (usually 90 to 5,000 tablets or capsules) and in some cases, unit-of-use containers, usually one month&#39;s supply, for shipment to distributors, pharmacy benefit managers (PBM&#39;s) and re-packagers. Method  200  proceeds to Step  215 .  
      Step  215  Attaching and Programming Reminder Devices to Unit-of-use Containers.  
      In Step  215 , dose-time reminder apparatus is programmed via suitable programming cradles connected wired or wirelessly to manufacturers&#39; container-filling-line PC&#39;s using a standard interface, such as universal serial bus, then attached to unit-of-use containers (EEC  305  described in Method  300  below) during filling and labeling operations using standard equipment such as a Sancoa/Wieler Outsert Placing machine modified and validated to industry and regulatory standards for this task. Pharmaceutical-packaging machinery and software engineers such as Luciano Packaging Technologies of Somerville, N.J. can readily develop, validate, and install programming and placement equipment and associated processes. Programming is set to activate the clock and memory the first time patients open the EEC  305 . It should be noted that, with proper training and quality control validation that, wholesalers, PBM&#39;s, re-packagers, and retail pharmacists could become qualified perform step  215 . It also should be noted that programming and/or attachment of dose-time reminder devices, including initializing reminder timing sequence in Step  282  below, may be done at separate points in the supply chain.  
      The dosage reminder device attached in Step  215  may be programmed for a dosing regimen, such as one or more doses per day; however, other regimens also may be programmed. Method  200  proceeds to Step  220 .  
      Step  220  Shipping Bulk Containers and Unit-of-use EEC  305 s to Distributors, PBM&#39;s and Re-packagers.  
      In Step  220 , medication in bulk containers and in unit-of-use EEC  305 s is shipped to distributors, PBM&#39;s, and re-packagers. Method  200  proceeds to Step  230 .  
      Step  230  Re-packaging Medication from Bulk into Unit-of-use EEC  305 s for Shipment with Bulk Containers to Dispensing Entity.  
      In Step  230 , distributors, PBM&#39;s, and re-packagers may re-package from bulk containers into smaller containers, including unit-of-use EEC  305 , to fill specific dispensing entity orders. Method  200  proceeds to Step  240 .  
      Step  240  Shipping Bulk and Unit-of-use EEC  305 s to Dispensing Entity  
      In Step  240 , re-packaged EEC  305 s and manufacturer-packaged EEC  305 s are shipped to the dispensing entity, e.g. a pharmacy chain. Method  200  proceeds to Step  250 .  
      Step  250  Dispensing Unit-of-use EEC  305 s or Decanting Medication from Bulk Containers into Patient-specific EEC  305 s  
      In Step  250 , Dispensing entity personnel may dispense unit-of-use EEC  305 &#39;s either from unit-of-use EEC  305 s filled upstream, if available, or by decanting from larger containers into a container specific to the patient&#39;s dosing regimen, commonly once daily, into a unit-of-use EEC  305 . Method  200  proceeds to Step  260 .  
      Step  260  Printing Patient-specific Dosage Instructions.  
      In Step  260 , dispensing entity manually or automatically prints patient-specific dosage instructions on a label suitable for attachment to the EEC  305  specific to the patient&#39;s dosing regimen. Method  200  proceeds to Step  270 .  
      Step  270  Attaching Dosage Instructions to Patient-specific EEC  305 s  
      In Step  270 , dispensing entity manually or automatically may attach the printed label produced in Step  260  to the EEC  305  specific to the patient&#39;s dosing regimen. Method  200  proceeds to Step  280 .  
      Step  280  Dispensing Medication to Patient  
      In Step  280 , the filled, labeled EEC  305  from Step  270  is dispensed to the patient; in some cases, such as PBM&#39;s, dispensing may be via mail or other shipment method. Method  200  proceeds to Step  285 .  
      Step  282  Initializing EEC  305  Reminder, Data-logging, Reminder-timing Sequence on First Use  
      In Step  282 , electronics programmed in Step  215  monitors the EEC  305  closure sensor. When the patient opens the EEC  305  first time, the reminder, data-logging, and reminder timing sequence processes are initialized. Initial opening and closing of said EEC  305  occurs at the time of day patients prefer or have been directed by a licensed medical professional to take each day&#39;s first dose. Opening and/or closing may automatically decrement the dose count and may electronically log the date &amp; time the EEC  305  was opened and closed. Method  200  proceeds to Step  285 .  
      Step  285  Signaling Patient to Take Medication  
      In Step  285 , EEC  305  signals patient reminder at dose time. Reminders can be of various types, including visual, audible, and textual. Method  200  proceeds to Step  286 .  
      Step  286  Decrementing Doses Remaining, and Logging Date and Time of Dispensing.  
      In Step  286 , opening and/or closing the container may automatically decrement the dose count and may electronically log the date &amp; time the container was opened and closed. Method  200  proceeds to Step  287 .  
      Step  287  Dose Count Low, Container Empty? 
      In step  287 , a decision is made whether the dose count logged in Step  286  reaches an established threshold, e.g., when about 25% of doses remain. If no, Method  200  returns to step  285 . If yes, Method  200  proceeds to Step  288 . If empty, Method  200  proceeds to Step  289 .  
      Step  288  Signaling Refill Reminder.  
      Step  288 , reminder device signals a refill reminder; signal means may include visually, audibly, and textually. Signaling may continue until no doses remain or patient acknowledges reminder as instructed by the label. Method  200  returns to Step  285 .  
      Step  289  Signaling Empty and/or Shutting Down.  
      In Step  289 , the electronically stored count of remaining doses is compared to the number of doses dispensed in step  280 . When the value reaches zero, no doses remain, causing EEC  305  to signal empty and/or shut down. Method  200  proceeds to Step  290 .  
      Step  290  Monitoring Patient Compliance Through Refill Frequency and Dispensing Date &amp; Time Data.  
      In step  290 , patient compliance with the dosage regimen may be determined through refill activity data and by downloading date and time of dispensing data logged in Step  286 . Method  200  ends.  
      System  300  in  FIG. 3  describes an example of Method  200 . System  300  is a novel system which collects patient feedback on preferences and effectiveness of container reminder methods for various patient segments in order to continually improve reminder methods, in turn continually increasing compliance and therapeutic outcomes.  
       FIG. 3  shows system  300  for increasing outpatient medication compliance which includes medication manufacturer  301 , medication dispensing entity  302 , Electronically Enhanced Container (EEC)  305 , container programmer  310 , prescription station  320 , patient reminder process  330 , patient data-logging process  340 , receiving station  350 , data path A  360 , data path B  370 , and compliance database  380 .  
      Medication manufacturer  301  is any primary medication manufacturer where prescription oral dose medication is produced and packaged for distribution to medication dispensing entities.  
      Medication dispensing entity  302  is any organization responsible for conveyance of medication to the patient. Types of medication dispensing entities may include pharmacies, hospitals, and dispensaries, pharmacy benefit managers (PBM), and other authorized entities, whether in person or by mail or other shipment means.  
      EEC  305  is a unit-of-use medication container that exhibits such functional capabilities as described in Table 1 below.  
                                   #   Electronically Enhanced Container 305 Functional Capabilities                                        1   Consists of materials approved by responsible agencies           for containing medications in tablet, capsule,           or other oral dose form       2   Signals patients at dose time w/o relying on patient action       3   Automatically senses and logs date &amp; time container           is opened and closed w/o relying on patient action       4   Signals when a period&#39;s dose has been taken           w/o relying on patient action       5   Memory, real-time clock, battery/other power source       6   Programmed and applied to containers at filling-line speed           (without slowing the line).       7   Meets IPC reliability standards for electronics;           mode of failure is to shut down       8   Meets FDA, USP container requirements       9   Accommodates child-resistant/senior friendly requirements       10   Warns when a period&#39;s dose has been taken,           avoiding double dosing.                  
 
      One example of a fully functional EEC  305  is described in United States patent application no. 20020104848, Pharmaceutical container having signaling means and associated method of use, which is hereby included by reference.  
      Container programmer  310  is a stand-alone or PC-based electronic device capable of interfacing with EEC  305  such that the initial command set for EEC  305  may be downloaded from the container programmer  310  to EEC  305 . The interface between container programmer  310  and EEC  305  may be any interface capable of reliably transferring data and may include electrical, optical, and RF. The command set may include executable software code, parameter files, and the like.  
      Prescription station  320  is a stand-alone or PC-based electronic device capable of interfacing with EEC  305  such that patient-specific dosing instructions and other information can be downloaded from prescription station  320  to EEC  305 . The interface between prescribing station  320  and EEC  305  may be any interface capable of reliably transferring data and may include electrical, optical, and RF. Patient-specific information may include patient name, dosing schedules, special instructions such as “take with food,” prescribing licensed medical professional name, expiration date, and dispensing entity contact information.  
      Patient Reminding Process  330   
      Patient reminding process  330  is the process by which the patient is reminded to take the prescribed dose at the prescribed intervals. Patient reminding process  320  includes instructions executed on the microcontroller electronics embedded in the container EEC  305 , various sensed interrupts (e.g. container opening/closing) and production of direct sensory alerts, including visual, audible, textual, etc.  
      Compliance Data-logging Process  340   
      Compliance data-logging process  340  is the process by which the level of patient compliance with the dosage regimen is recorded. Compliance data-logging process  340  includes instructions executed on the microcontroller electronics embedded in container EEC  305 , various sensed interrupts (e.g. container opening/closing), and data storage (e.g., time and date of container opening and closing).  
      Receiving station  350  is a stand-alone or PC-based electronic device capable of interfacing with container EEC  305  such that information can be uploaded from EEC  305  to receiving station  350 . Receiving station  350  may also be connected to data path A  360  and/or data path B  370 . Functionality of receiving station  350  and prescribing station  320  may reside on the same hardware.  
      Compliance database  380  is any flat file or relational database for storing the patient compliance information downloaded from EEC  305  over Data Path B  370  and from Receiving station  350 . Patient compliance data may be in anonymous form, i.e. patient identification is not included in data compilation and analysis.  
      Method  400  in  FIG. 4  is a detailed method of using system  300  to increase patient compliance to a dosing regimen and includes the following steps:  
      Step  410  Packaging Oral Dose Forms in Containers at Medication Manufacturer  
      In Step  410 , medication in oral dose forms (e.g. tablets and capsules) is packaged in containers at manufacturer  301 . Method  400  proceeds to Step  420 .  
      Step  420  Packaged in EEC  305 ? 
      In Step  420 , a decision is made whether the oral dose form is already packaged in EEC  305  30-day containers EEC  305 . If the decision is yes, Step  420  proceeds to Step  425 . If the decision is no, Method  400  proceeds to Method  500 .  
      Step  425  Packaging Oral Dose Form Medication Directly into EEC  305 .  
      In Step  425 , oral dose form medication is packaged in EEC  305  and programmed, most commonly for one dose per day, however other dosing regimens also can be programmed. Method  400  proceeds to Step  430 .  
      Step  430  Shipping Unit-of-use Containers  
      In Step  430 , EEC  305 &#39;s filled and programmed in Step  425  are shipped to wholesalers, PBM&#39;s, re-packagers, and/or dispensing entity. Method  400  proceeds to Step  450 .  
      Step  450  Processing Patient-specific Information  
      In Step  450 , patient-specific information may be input into prescription station  320 . An EEC  305  filled with the appropriate type and number of oral dose form medication is selected and may be connected to prescription station  320  in such a manner as to allow transfer of data. Prescription station  320  establishes data communication with the selected EEC  305 , performs any required checks, and downloads the patient-specific prescription information, including whether compliance data will be captured for analysis as well as for inputs such as to verify and otherwise treat dosing regimen, to the electronic memory resident on EEC  305 . Method  400  proceeds to Step  455 .  
      Step  455  Dispensing to Patient  
      In Step  455 , the fully configured EEC  305  is physically dispensed to the patient in person, r by mail, or by other shipment means. Method  455  proceeds to Step  460 .  
      Step  460  Executing Patient Reminder Process  
      In Step  460 , the reminder process is initiated upon patients first opening the container at the time of day they prefer or have been directed by their licensed medical professional to dake each days&#39;/periods&#39; dose. Such initialization also may be done during programming in Step  450 . Method  400  proceeds to Step  470 .  
      Step  470  Is Compliance Being Monitored? 
      In Step  470 , EEC  305  checks whether data-capture status is enabled. If yes, Method  400  proceeds to Step  480 . If no, Method  400  ends.  
      Step  480  Monitoring Compliance and Returning/shipping Empty Containers  
      In Step  480 , empty containers are collected for data downloading. Collection means include patient delivering the empty in person or mailing it to the dispensing entity, delivering or shipping to a designated data-collection facility in a postage-paid envelope conveyed with the EEC 305 , following the way in which HP supplies such envelopes for recycling spent printer cartridges. For patients, empty containers may function as a coupon for reduced (or zero) co-payment on their refill, money off other drugstore merchandise, etc. Other patient incentives may include reduction in health insurance premiums. Method  400  proceeds to Step  490 .  
      Step  490  Uploading Compliance Data  
      In Step  490 , data is read from empty EES  305  such as at the point of receipt of the empty container and/or a central data-collection facility to which the container has been relayed from the point of receipt. A stand-alone or PC-based electronic device such as a cradle or wand reads the empty container&#39;s data by electrical contact or wirelessly may then relay the data to a central database for logging and analysis. Method  400  ends.  
       FIG. 5  illustrates Method  500 , which describes an alternate medication distribution method in more detail than the method steps  450  through  490  of Method  400  and includes the following steps:  
      Step  510  Packaging Oral Dose Form Medication in Bulk by Manufacturers  
      In Step  510 , oral dose form medication is packaged by manufacturers in bulk containers for shipment, usually 90 to 5,000 doses. Method  500  proceeds to Step  520 .  
      Step  520  Shipping Bulk Containers to Wholesalers, PBM&#39;S, and Re-packagers.  
      In Step  520 , bulk containers filled in step  510  are shipped to wholesalers, PBM&#39;s, and re-packagers. Method  500  proceeds to Step  530 .  
      Step  530  Decanting Bulk Medication into EEC  305  30-day-supply Containers  
      In Step  530 , supply chain stakeholders such as wholesalers, PBM&#39;s, and re-packagers decant oral dose forms from bulk into EEC  305 . Method  500  proceeds to Step  540 .  
      Step  540  Shipping EEC  305  to Medication Dispensing Entity/patient  
      In Step  540 , EEC  305 &#39;s filled in Step  530  are shipped to the dispensing entity, most commonly a retail pharmacy, and may include a PBM who may ship EEC  305 &#39;s directly to patients. Method  500  ends.  
       FIG. 6  illustrates Method  600 , which describes in more detail the preferred embodiment of the method steps  450  through  490  of Method  400  and includes the following steps:  
      Step  605  Inputting Patient-specific Information  
      In step  605 , patient-specific information is input into prescription station  320  on site of the medication dispensing entity, including whether compliance will be monitored. Patients may specify whether compliance will be monitored and if so where such data may be shared. Method  600  proceeds to Step  610 .  
      Step  610  Preparing EEC  305   
      In Step  610 , prescription station  320  prepares EEC  305  for dispensing to the patient. Prescription station  320  prints the appropriate prescription instruction label for EEC  305  and any other instructions required for dispensing. Prescription station  320  also may download appropriate data to the electronic patient-reminder and compliance-data-logging programming to electronics of EEC  305 . Data may include such information as dose count (number of doses in the container), dosing regimen, dosage period, date, patient name, number of refills remaining on prescription, and expiration date. Prescription station  320  may be equipped to program reminder type and frequency, including revising programming of EEC  305 , such as type of reminders, that may have been performed upstream at the factory or by other supply chain stakeholders, such as wholesalers, PBM&#39;s, and re-packagers.  
      Step  620  Dispensing to Patient  
      In Step  620 , dispensing entity  302  physically conveys EEC  305  to the specific patient. A dispensing entity also may mail or ship medicines in EEC  305  to patients.  
      Step  625  Initializing Reminder/data-logging on First Use  
      In Step  625 , the microcontroller electronics embedded in EEC  305  monitors the container closure sensor. When the patient opens EEC  305  the first time, the reminder/data-logging processes are initialized. Initial opening of and EEC  305  occurs at the time of day patients prefer or have been directed by a licensed medical professional to take each day&#39;s first dose. Initialization also may be performed in Step  610  Method  600  proceeds to Step  630 .  
      Step  630  Executing Patient Reminder-timing Sequence  
      In Step  630 , the microcontroller electronics embedded in EEC  305  executes a reminder timing sequence algorithm such that the duration of the timing corresponds to the prescribed time between doses. Method  600  proceeds to Step  635 .  
      Step  635  Reminding the Patient to Take Prescribed Dose  
      In Step  635 , EEC  305  produces sensory directed output to remind the patient to take the appropriate dose of prescribed medication at the proper time. The sensory directed output may include audible, visual, textual, and vibratory signals. Opening and/or closing EEC  305  terminates the reminder signal. Method  600  proceeds to Step  640 .  
      Step  640  Container Opened Within Time Limit? 
      In Step  640  the microcontroller electronics embedded in EEC  305  monitors the container closure switch. When the container is opened, EEC  305  proceeds to Step  645 . If EEC  305  is not opened within the specified time limit, Method  600  Proceeds to Step  641 .  
      Step  641  Signaling Missed Dose.  
      In Step  641 , EEC  305  electronics sense when such time has passed that a period&#39;s dose has been missed and signal missed dose via a sensory directed output including audible, visual, textual, and/or vibratory. Method  600  proceeds to Step  655   
      Step  645  Container Closed Within Time Limit? 
      In Step  645  the microcontroller electronics embedded in EEC  305  monitors the container closure sensor/switch mechanism. When the container is closed, EEC  305  proceeds to Step  655 . If EEC  305  is not closed within the specified time limit, Method  600  proceeds to Step  650 .  
      Step  650  Signaling: Close Container  
      In Step  650 , an alarm sequence is initiated to alert the patient that EEC  305  container is open and needs to be closed. The alarm sequence produces a sensory directed output (audible, visual, textual, and/or vibratory) that is specific to alarm condition. Method  600  returns to Step  645 .  
      Step  655  Decrementing Dose Count and Updating Compliance Records  
      In Step  655 , the electronically stored count of remaining doses in container EEC  305  is decremented by one. In addition, compliance data such as dose-taken time and date is stored in non-volatile memory of EEC  305 . In the event of a missed dose in Step  641 , the dose count is not decremented and the absence of the container being opened and closed at dose time is evident in non-volatile memory. Method  600  proceeds to Step  660 .  
      Step  660  Dose Count Low/empty? 
      In Step  660 , the electronically stored count of remaining doses in EEC  305  is compared to a value established for a low dose-count condition, e.g. when about 25% of doses remain. If a low dose count condition does not exist, Method  600  proceeds to Step  630 . If a low dose count condition exists, Method  600  proceeds to Step  665 . If empty, Method  600  proceeds to Step  668 .  
      Step  665  Signaling Refill Reminder  
      In Step  665  an enunciator sequence is initiated to alert the patient that the prescription needs to be refilled. The enunciator sequence produces a sensory directed output (audible, visual, textual, and/or vibratory) that is specific to the refill-needed condition. Signaling may continue until no doses remain or until the patient acknowledges the reminder as instructed by the label. Method  600  returns to Step  630 .  
      Step  668  Signaling Empty Container  
      In Step  668 , the electronically stored count of remaining doses in EEC  305  is compared to the number of doses dispensed in step  620 . When the value reaches zero, no doses remain, causing EEC  305  to signal empty and/or shut down. Method  600  proceeds to Step  670 .  
      Step  670  Collecting Compliance Data? 
      In Step  670 , if directed in Step  605  that an individual patient&#39;s compliance would be monitored, Method  600  proceeds to Step  680 . If the decision is no, Method  600  ends.  
      Step  680  Collecting Empty EEC  305 &#39;s and/or Collecting Compliance/usage Data  
      In Step  680 , empty EEC  305 &#39;s are collected for data collection and/or polled for data at remote sites such as patient&#39;s homes, caregiver&#39;s sites, doctor&#39;s office, etc. EEC  305  collection means include patient delivering the empty in person to the dispensing entity, delivering or shipping to a data-collection facility, etc. For incentives to patients, empty EEC  305  may function as a coupon for reduced (or zero) co-payment on their refill, money off other drugstore merchandise, etc. Other patient incentives may include reduction in health insurance premiums.  
      Once in hand spent EEC  305  data is read at the point of receipt of the empty container and/or at a central data-collection facility to which the container has been relayed from the point of receipt, and/or at a reader placed in patients&#39;/caregivers&#39; homes, and the like A stand-alone or PC-based electronics peripheral device such as a cradle or wand may read the empty container&#39;s data by electrical contact or wirelessly, which then may be relayed via WEB or other network to a central database for logging and analysis. Method  600  ends.  
      Once compliance data has been uploaded, in can be analyzed for insights such as specific patient outcomes, effectiveness of types of reminders for various patient groups, and the like. Patient-specific data also can be share with patients and their licensed medical professionals for insights into, increasing compliance, treatment effectiveness, and the like.  
       FIG. 7  illustrates Method  700 , which describes a method for determining compliance with a dosing regimen and includes the following steps:  
      Step  710  Uploading Local Compliance Data to Database  
      In Step  710 , refill frequency and date &amp; time of daily dispensing data collected from compliance containers, such as EEC  305 , in Step  680  is uploaded to a specified database for analysis via WEB or other network. Method  700  proceeds to Step  720 .  
      Step  720  Analyzing Compliance Data  
      In Step  720 , data uploaded in Step  710  is analyzed for such insights as level of patient compliance, effectiveness of types of reminders for increasing compliance for various patient groups, e.g., elderly, busy executives, and stay-at-home parents. Results and recommendations may be generated, including patient-specific, and non-patent-specific (anonymous) trends, and the like. Analysis also may enable optimization of the types of reminders shown to be most effective for various patient group lifestyles. In fact, reminder-type and other compliance enhancing recommendations can be made specifically for patient age groups. For example, frantically busy business people in their 40&#39;s may want distinctively loud and clear alerts like intense LED&#39;s and bells, while retired patients are may prefer doorbell-like chimes and/or slow-blinking, dim flashes. Continuously tailoring reminders using EEC  305  usage information for specific patient segments may be expected to continuously improve compliance collectively. Method  700  proceeds to Step  730 .  
      Step  730  Accumulating Compliance Data in Registry? 
      In Step  730 , if patient specified inclusion in a patient registry in Step  605 , their compliance data is sent via WEB or other network to Registry  735  for comparison to and analysis among the registry&#39;s population. Registry may collect and collate other information, such as treatment outcomes relative to compliance, leading to recommendations and actions by the medical community to improve health-care effectiveness and lower overall health care costs. Registry may include data on effectiveness of reminder type for various patient groups as describe above in Step  720 . Method  700  proceeds to Step  740 .  
      Step  740  Reporting Patient-specific Compliance Data to Stakeholders? 
      In Step  740 , if patient specified in Step  605  that compliance data be conveyed to stakeholders such as his/her medical professional, Health insurance company, and the like, Method  700  proceeds to Step  750 . If the patient specified in Step  605  that compliance data not be conveyed to such stakeholders, Method  700  ends.  
      Step  750  Generating Patient-specific Compliance Report.  
      In Step  750 , a patient-specific compliance report may be generated from compliance database in Step  710  and analyzed in Step  720  of Method  700  which details such information as patient name, medication name, doctor&#39;s name report date, reminder time, date &amp; time of container opening and closing, double dose attempts, percent compliance, and the like.  FIG. 9  illustrates the sample report.  FIG. 10  illustrates the sample report with select fields populated with examples of data. In the example of  FIG. 10 , patient John Smith complied January 2006 at a level of 80% The data tell that Patient Smith misses most weekend doses 6, 7, 14, 19, 20, and 27, although he took doses on two Saturdays 13, 26, weekend doses prove a persistent difficulty. Recommendations from Compliance Registry Analysis  100  performed or sponsored by one or more stakeholders such as pharmaceutical manufacturers, HIC&#39;s, and others, generate recommendations for Reminder Signal type  101  sounding a louder chime on weekends and Techniques to aid recall  102 , providing an extra reminder on Friday to take weekend doses.  
      Method  700  proceeds to Step  760 .  
      Step  760 , reporting patient-specific compliance data and/or recommendations to stakeholders.  
      In Step  760 , the report generated in Step  750  is conveyed via WEB or other network, by mail or other shipment means. The report can be sent via these means to stakeholders such as the patient, caregiver, doctor, and/or health insurance company (HIC) or may be collected by the patient via such means or at such a location as the dispensing entity to take to an appointment with a licensed medical professional, depending on the professional&#39;s preferences, and/or for conveyance to HIC. Doctors would use this information such as for assessing therapeutic efficacy of a course of treatment while HICs may be inclined to reward compliance economically such as with reduced deductible payments and co-payments and/or reduction in premium. Returned spent containers may function as coupons redeemable for such financial rewards and/or merchandise at the retail point of container return and/or dispensing. Method  700  ends.  
       FIG. 8  illustrates Method  800 , which describes a method for determining return on investment in compliance reminder signaling devices and related methods, and/or other reminder methods and includes the following steps:  
      Step  805 , Generating Patient Specific Compliance and/or Recommendations  
      In Step  805  a patient-specific compliance report is generated from compliance database in Step  710 . which details information which may be of interest to stakeholders such as patient name, medication name, doctor&#39;s name report date, reminder time, date &amp; time of container opening and closing, double dose attempts, percent compliant, and the like.  FIG. 9  illustrates the sample report.  FIG. 10  illustrates the sample report with select fields populated with examples of data, which is described above in Step  750  of Methiod  700 . Method  800  proceeds to Step  810 .  
      Step  810 , Reporting Patient-specific Compliance Data and/or Recommendations to Stakeholders.  
      In Step  810 , the report generated in Step  810  and/or in step  760  of Method  700  is conveyed via WEB or other network, by mail or other shipment means, such as DHL, FedEx, and the like. The report can be sent via these means to stakeholders such as the patient, caregiver, doctor, Health Insurance Company (HIC) and/or pharmaceutical manufacturer (PM). PM&#39;s may assess this information to inform their choices such as about whether and how much to invest and/or continue investing in increasing patient compliance. This analysis may include such measures as increases in revenue and/or profit from investment in reminder signaling devices and related methods, and/or other compliance-increase methods and/or patient incentives, such as reduction in co-pay, and/or money off other products at the retail dispenser&#39;s store. Returned spent containers may function as coupons redeemable for such financial rewards. Method  800  proceeds to Step  820 .  
      Step  820 , Compliance-increase Target Achieved? 
      In Step  820 , a decision is made whether the anticipated compliance increase achieves a specific target increase such as 10%. In the case of Lipitor, which generates $10 billion in sales annually, a 10-percent increase would be $1 billion in incremental sales. Other blockbuster drugs, those generating $1 billion or more in annual sales, would generate similarly compelling financial numbers. If the answer is yes, Method  800  proceeds to Step  830  If the answer is no method  800  proceeds to Step  840 .  
      Step  830  Documenting Return on Increased Compliance  
      In Step  830 , stakeholders such as pharmaceutical companies and/or others paying for compliance-increase devices, such as EEC  305 , and/or other compliance-increase methods, may document such stakeholders&#39; return on investment in increasing compliance. In the case of Lipitor, which generates $10 billion in sales annually, a 10-percent increase in compliance would generate $1 billion in incremental sales. If each EEC  305  cost $1 and 100 million EEC 305  containers would be needed for Lipitor&#39;s annual sales volume, the variable cost increase of $100 million for EEDC  305  containers would generate a ten-fold return on investment—far more than the customary investment threshold of one to two-fold returns. Further, such an increase in sales would require none of the ponderous R&amp;D spend for which the pharmaceutical industry is known. Accordingly, such incremental sales increase would be at a higher profit than a new product generating the same revenue increase. Stakeholders such as pharmaceutical companies or HIC&#39;s in such circumstances would have information to inform whether to continue making the investment in increasing compliance and/or increasing this investment by turning some portion of the incremental profit back into increasing compliance still further. Method  800  proceeds to Step  840 .  
      Step  840 , Optimizing Reminder-type Signal Devices and Associated Methods.  
      In Step  840 , stakeholders such as pharmaceutical companies may analyze patient compliance data gathered and analyzed in Step  720  of Method  700  for such insights into reasons for level of a patient&#39;s compliance, effectiveness of types of reminders for increasing compliance for various patient groups, e.g., elderly, busy executives, and stay-at-home parents. Results and recommendations may be generated, including patient-specific, and non-patent-specific (anonymous) trends, and the like. Analysis also may inform optimization of the types of reminders shown to be most effective for various patient group lifestyles. In fact, reminder-type and other compliance enhancing recommendations can be made specifically for patient age groups. For example, frantically busy business people in their 40&#39;s may want distinctively loud and clear alerts like intense LED&#39;s and bells, while retired patients are may prefer doorbell-like chimes and/or slow-blinking, dim flashes. Continuously tailoring reminders using EEC  305  usage information for specific patient segments may be expected to continuously improve compliance collectively. Method  800  proceeds to Method  400 .  
      6.1 Conclusion  
      In addition to the features and advantages of the invention explicitly detailed herein, numerous modifications and changes will readily occur to those of ordinary skill in the art upon review of this disclosure. The invention should be understood to include all such limitations. Accordingly, all suitable modifications and equivalents should be considered as falling within the spirit and scope of the invention.