Improving Medication Adherence: Keep Your Eyes on the Prize

Abstract

M edication adherence is a set of complex health behaviors that challenges patients of all ages and health conditions. Researchers have spent decades trying to improve medication adherence, and yet these interventions have been wrought with limitations and sobering findings. The most recent Cochrane systematic review of the impact of adherence interventions found that effects were inconsistent across studies and that only a small number of interventions led to a modest improvement in both adherence and clinical outcomes. 1 The authors concluded that existing adherence interventions Bare mostly complex and not very effective.^1 In addition, the authors recommended that future research include robust study designs of feasible long-term interventions with sufficient study power to detect improvements in patientcentered clinical outcomes. 1A key issue in implementing any adherence intervention is ensuring valid measurement of adherence. Measurement of medication adherence is complex, since most measures serve as proxies for medication-taking behavior.2 For example, pharmacy claims data are increasingly used for conducting adherence research, although the pharmacy claim serves only as a proxy for medication consumption, and in reality it is simply measuring refills. Other methods for measurement, including self-report, pill counts, and electronic capture of pill bottle opening, also require important assumptions about the relationship between the measure and actual medication-taking. It is further assumed that improving medication adherence will improve process measures such as blood pressure or cholesterol control, which will in turn improve the health outcome(s) of patients including quality of life and mortality.In this issue of JGIM, Reddy and colleagues present findings on the effect of daily pill bottle alarms combined with individual or partner feedback reports on statin medication adherence.3 This 3-month, three-arm randomized clinical trial randomized 126 veterans with known coronary artery disease and poor adherence (medication possession ratio [MPR] <80 %) to one of three groups: (1) a control group that received a pill-monitoring device (i.e., a GlowCap ® bottle) with no alarms or feedback; (2) an individual feedback group that received a daily alarm and a weekly medication adherence feedback report; and (3) a partner feedback group that received an alarm and a weekly feedback report that was shared with a friend, family member, or a peer. By the end of the 3-month intervention, statin adherence was significantly higher in both the individual and partner feedback groups compared to the control arm (89 % and 86 % vs. 67 %, respectively). However, at 6 months, statin adherence did not differ among the groups (60 % and 52 % vs. 54 %).The study had a number of strengths and unique aspects. First, the use of a feedback component in the intervention arms was a novel approach. The authors were thus able to assess the impact of peer support (via social forces) or individual feedback on medication adherence behavi...

Evaluating the potential costs and impact of digital health technologies for tuberculosis treatment support

“…Digital technologies have been evaluated extensively and used successfully to improve outcomes in HIV and other chronic diseases. They have been associated with improved adherence to treatment, with some initial evidence in the TB context [ 14 – 17 ]. The WHO guidelines on the management of LTBI recommend monitoring treatment using digital technologies [ 8 ] to further patient-centred care and support, key elements of the TB elimination framework [ 9 ].…”