EDITOR'S PEN

Caregiver Thought Leader Interview: 
Robert Gable

Gary Barg:  According to the Center for Disease Control and Prevention, up to 59 percent of those on five or more medications per day are taking them improperly and 22 percent of Americans take less of the medication than is prescribed on the label. There are nearly 700,000 emergency department visits for adverse drug events in the U.S. for adults age 65 or older. And 23 percent of nursing home admissions are due to patients failing to take their prescription medications accurately. Wow. What’s going on? And what do we do about it?

Robert Gable:  It really is a serious problem. And, when I first got into this, I started doing some digging. At first, I thought it was just people forgetting, but it’s actually a very extreme, complex issue. Part of the problem is poor communication between a patient and their doctor; 24 percent of prescriptions written by a doctor are never filled. So that’s huge, also. And patients, because they go to multiple doctors, are not always communicating about the medications they are taking with all of their doctors.

We have a doctor on our advisory board and she has been adamant about telling people they should take all their medications and put the bottles into a brown bag when they go to see their doctor. They need to set all the bottles out on a desk and have a very sincere conversation about everything they are taking. One of the other big issues is to be absolutely honest with your doctor.  It’s really a very complex problem. And it’s going to take a team effort with patients, doctors and caregivers working together to try to help solve this.

Gary Barg:  What have you decided to do at myMar to help combat medication noncompliance?

Robert Gable:  We will either provide a phone call, a text message or an email to an individual to remind them to follow their medication plan. Under no circumstances would we ever remind somebody to take their medication because we’re not in the house and we don’t know what people have already taken. And one of the things that I fear the most is that somebody would over medicate. That could be a serious problem also. 

We have done extensive research with the work the National Institute on Health has done and other caregiver providers as far as medication adherence and the issues around it. Our process is that we can call you once, twice, three times or even four times a day. We even have a deluxe package for people who are getting closer to the onset of dementia where they really need to be reminded to take not only their medications, but fluids or that it’s meal time. 

We wanted to keep it simple, but effective. And we have seen some really good results. The family of one of our newest clients was about ready to place her into a nursing home. But since she’s been on our program, she has not missed one medication time. She just had a doctor’s visit and the doctor was absolutely amazed at her progress and the improvement in her health since using our system. 
 
Gary Barg:  I always look for the simplest, most direct and straightforward solution to any healthcare challenge.  I remember how hard it was to get my grandfather to understand how to work a phone-recording machine. What I think is so exciting about this, is that it actually uses a device that everyone is familiar with. It’s a phone call. 

Robert Gable: Part of it really is educating people that if they’re going to be more mobile, the call can come through on a cellular device, as well. We’ve tried to keep it really simple. And it seems to be paying dividends as far as helping people. For the senior population right now, the phone calls seem to be the most widely received. They can be a little apprehensive about text messaging, emails and things like that. 

Gary Barg:  So what are caregivers saying to you about the service?

Robert Gable:  It has really helped them—especially in situations where the caregiver lives far from their parent. It allows them the comfort of knowing that every day they’re going to get that reminder. Our service is backed up by a secondary service so that if the first would fail, the second one kicks in to try to ensure 100 percent satisfaction.  It’s very tiring for caregivers when they’re constantly trying to remember to call Mom or Dad or their aunt or uncle and tell them to take their medications. 

The dad of one of our very first clients had the onset of dementia and she was constantly calling him to remind her dad what time of day it was, or to eat, or even to drink water. We were able to regiment his lifestyle for him. Her dad’s doctor told her that the longer he was able to stay in his residence, the longer his lifespan would be. She was literally crying when she was telling us this because we had taken such a burden from her of having to be on the phone all the time calling to remind him.   

Gary Barg:  I can see the challenge you’re solution is helping us with as family caregivers. How did you think of myMar?  

Robert Gable:  It actually fell into my lap. My dad had passed away and my mom just seemed so dependent on my dad. When a friend of mine was talking with me about starting a business, I thought we should look into a concierge service for senior citizens. I went to a senior expo. I didn’t have any products, but I got a booth. I just wanted to see what they would be interested in as far as products or services that I could offer. And I had a nice pamphlet made up with questions such as, Would you be interested in having your laundry taken care of? Yard services? Snow shoveling? Meals delivered? Take you grocery shopping? I didn’t have one person who was interested in any of that stuff. But, I had over 10 people write down that they wanted to be reminded to take their medicine. 

Gary Barg:  That’s interesting.
 
Robert Gable:   I asked my pharmacist if she ever met anybody who forgets to take their medicine. Her jaw just dropped and she said, “You have no idea how big a problem that is.”  That’s how we got into it. It was just pure luck on our part. 
 
Gary Barg:  We’re not just talking about using this for our senior loved ones. It can be utilized for everything from ADHD to ALS, arthritis, diabetes and even birth control pills.

Robert Gable:  Right. Until I started doing the research, I wouldn’t have even thought of this, but over 600,000 pregnancies last year were unplanned due to non-adherence to birth control pills.

Gary Barg:  So tell me, if you only had one piece of information that you would like to share with a family caregiver, what would that be?

Robert Gable:  The key is to remember that it’s going to take a team effort with the caregiver, the patient and the doctor. The communication process is just huge, and so important. The doctor is treating the patient based on assumptions that all medications are being taken at the right time. And if they are not, that doesn’t allow the doctor to totally understand what’s going on. The conversation from the doctor to the patient should thoroughly explain what the medication is doing for the patient. I call it the what, why, when and how. Explain what the medicine is going to do. Why it’s going to help the patient. When they need to take it and how they need to take it. 

We strongly encourage our clients to maintain a journal. When you are at the doctor’s office, you might forget how you were feeling a week ago, when you ate a certain meal that your medicine seemed to have a reaction to, or whatever. That journal is a very good tool for having educational conversations with your doctor.