Effect of Reminder Devices on Medication Adherence

Abstract

IMPORTANCEForgetfulness is a major contributor to nonadherence to chronic disease medications and could be addressed with medication reminder devices.OBJECTIVE To compare the effect of 3 low-cost reminder devices on medication adherence.DESIGN, SETTING, AND PARTICIPANTS This 4-arm, block-randomized clinical trial involved 53 480 enrollees of CVS Caremark, a pharmacy benefit manager, across the United States. Eligible participants were aged 18 to 64 years and taking 1 to 3 oral medications for long-term use. Participants had to be suboptimally adherent to all of their prescribed therapies (with a medication possession ratio of 30% to 80%) in the 12 months before randomization. Participants were stratified on the basis of the medications they were using at randomization: medications for cardiovascular or other nondepression chronic conditions (the chronic disease stratum) and antidepressants (the antidepressant stratum). In each stratum, randomization occurred within blocks defined by whether all of the patient's targeted medications were dosed once daily. Patients were randomized to receive in the mail a pill bottle strip with toggles, digital timer cap, or standard pillbox. The control group received neither notification nor a device. Data were collected from February 12, 2013, through March 21, 2015, and data analyses were on the intention-to-treat population. MAIN OUTCOMES AND MEASURESThe primary outcome was optimal adherence (medication possession ratio Ն80%) to all eligible medications among patients in the chronic disease stratum during 12 months of follow-up, ascertained using pharmacy claims data. Secondary outcomes included optimal adherence to cardiovascular medications among patients in the chronic disease stratum as well as optimal adherence to antidepressants. RESULTSOf the 53 480 participants, mean (SD) age was 45 (12) years and 56% were female. In the primary analysis, 15.5% of patients in the chronic disease stratum assigned to the standard pillbox, 15.1% assigned to the digital timer cap, 16.3% assigned to the pill bottle strip with toggles, and 15.1% assigned to the control arm were optimally adherent to their prescribed treatments during follow-up. There was no statistically significant difference in the odds of optimal adherence between the control and any of the devices (standard pillbox: odds ratio [OR], 1.03 [95% CI, 0.95-1.13]; digital timer cap: OR, 1.00 [95% CI, 0.92-1.09]; and pill bottle strip with toggles: OR, 0.94 [95% CI, 0.85-1.04]). In direct comparisons, the odds of optimal adherence were higher with a standard pillbox than with the pill bottle strip (OR, 1.10 [95% CI, 1.00-1.21]). Secondary analyses yielded similar results.CONCLUSIONS AND RELEVANCE Low-cost reminder devices did not improve adherence among nonadherent patients who were taking up to 3 medications to treat common chronic conditions. The devices may have been more effective if coupled with interventions to ensure consistent use or if targeted to individuals with an even higher risk of nonadherence.TRIAL REGISTRATION ...

Reaching cardiovascular prevention guideline targets with a polypill-based approach: a meta-analysis of randomised clinical trials

“…Further, there was no significant difference in the improvement in adherence whether the intervention was simple or complex (two or more components) 38. The reviewers concluded that ‘simple one-component interventions might be a promising way to improve medication adherence in a CHD population, as they would be easier to replicate in different settings and on a large scale.’38 However, recent trials that have assessed alternatives to polypill-based care (reminder devices either alone39 or in combination with financial incentives and social support40) have found no statistically significant difference in adherence to usual care.…”

High-Definition Medicine

“…Other monitoring devices include mobile device medication reminders, smart pillboxes that track vial openings, and ingestible pill biosensors (Checchi et al, 2014). The clinical benefit of these devices for improving long-term compliance is still lacking (Choudhry et al, 2017). Systematic collection of treatment compliance data, health status, and patient outcomes are needed to determine which treatments and patient compliance strategies provide maximal clinical benefit.…”

Evidence and tips on the use of medication compliance aids

“…In contrast, a randomised controlled trial of more than 53 000 patients aged 18-66 who were taking three medications or fewer and using one of three reminder devices did not show any evidence of improved adherence compared with controls 16. These findings may not be transferable to the older cohort, who often use multi-compartment MCAs for polypharmacy in the UK.…”