That's often a nagging question long-distance baby boomer caregivers face when assessing the likelihood that their parents took their medication as prescribed.
Technology may have a solution. Efforts are under way to transform the little plastic pillbox into a smart device that in some cases is also a portal of information.
"You have situations where Mom lives in California, and I live in New York, and the question is, 'How do I deal with it?'" said Lisa Gables, executive director for the American Society of Consultant Pharmacists Foundation.
The changes can't come fast enough for many of the 34 million Americans who are providing care to aging family members. According to a 2004 study by MetLife (PDF), 15 percent of the caregivers polled lived at least an hour away from an ailing family member.
Today's high-tech pillboxes try to satisfy a number of tasks--alerting people when it's time to take medication, organizing pills into compartments, dispensing the proper dose and offering overall medication management.
Many pillboxes on the market issue simple alerts. These range from e-Pill's Pager Vibrating Medication Reminder device, which resembles a pager, to its Cadex Medication Reminder Watch with multiple, programmable alarms. These devices, however, do not organize, dispense or monitor pill consumption.
Dispensing features are important, stressed Majd Alwan, director of the Center for Aging Services Technologies. He noted that dispensing features serve as a mechanism for preventing overdosing by withholding medication if a patient skips a session and tries to "catch up."
More sophisticated devices try to tackle multiple tasks. For example, Aardex Group's Medication Events Monitoring Systems organize and monitor whether pills are taken at the prescribed time of day but require a trained medical professional to read the results transmitted from a person's computer.
Another device, e-Pill's Med-Time XL, will remind patients to take their pills, plus organize and automatically dispense them at the prescribed time. But it does not offer a monitoring service, Alwan said.
Pillboxes such as Honeywell's HomMed Health Monitoring System and InforMedix's Med-eMonitor Device, remind, organize and monitor, but do not include pill-dispensing features. Both devices also connect to health care professionals who monitor the data.
InforMedix is working on a Med-eMonitor consumer version, which is expected to come out by summer's end, said Dr. Bruce Kehr, founder and chief executive of the company.
As part of a $59 monthly service, the consumer device will send e-mails or text messages to someone if there's a problem with a family member's adherence to a medication regimen. If the family uses the device in conjunction with a professional monitoring service called ExcelleRX, the fee averages about $65 per month.
"Most of us have family members who are on lots of medications, who either live alone or with another elderly person," Kehr said. "We've teamed up with ExcelleRX, who will set up the device and program it over the Web. So family members can either get the notifications, or add ExcelleRX if they want a professional to do the monitoring."
The MD.2 pill dispenser by e-Pill is another consumer device that allows adult children to serve as caregivers to their parents by programming the dispenser, refilling its contents and having data about medication taken transmitted to the caregiver's computer.
MD.2, however, does not come cheap. The device costs $799, and family members who wish to have their loved ones' medication management constantly monitored in real time, pay an additional $29 per month for the added service after a free, two-month introduction period. Family members can also forgo the professional monitoring service and set up the device to issue a phone call to up to five designated family members or caregivers if the patient fails to take their pills within 90 minutes of the assigned time.
"Crude versions of (futuristic medication management) technology exist now, but it's difficult to set up unless you have a smart teenager that can wire it up for you," said Eric Dishman, general manager and global director of the Intel Health Research & Innovation Group. Intel and Accenture are two industry titans investing in medication management research.
Alwan, meanwhile, said he expects other devices to eventually emerge on the market.
"There's a lot of development activity in this area," Alwan said. "It's well known that mediation compliance is the important issue for all three groups involved--the older adults, the adult children of these adults and the professional caregivers like aides, nurses and physicians."