Ingestible electronic sensors to measure instantaneous medication adherence: A narrative review

Abstract

Objective Medication nonadherence contributes to significant morbidity and mortality worldwide. While many techniques to measure adherence exist, digital pill systems represent a novel, direct method of measuring adherence and a means of providing instantaneous adherence supports. In this narrative review, we discuss digital pill system research based on clinical trials and qualitative investigations conducted to date and potential future applications of digital pill system in medication adherence measurement. Methods We conducted a literature search in PubMed of English language peer-reviewed articles describing the use of digital pill system for medication adherence measurement between 2000 and 2021. We included all articles that described the deployment of ingestible sensors and those involving qualitative investigations of digital pill system with human subjects. Results A total of 95 articles were found on initial search; 75 were removed based on exclusion criteria. Included articles were categorized as investigations that deployed an ingestible sensor in human populations ( n = 18), or those that conducted qualitative work ( n = 3). For pilot studies, the mean accuracy of the sensor to successfully detect a medication ingestion event ranged from 68% to 100%. When digital pill systems were deployed in real-world clinical settings, accuracy ranged from 68% to 90% with lower accuracy due to nonadherence to digital pill system technology. Qualitative studies demonstrated that providers and patients perceive the digital pill system as a facilitator for improving adherence and as a potential platform for delivering adherence interventions. Additionally, ingestion data from digital pill system was viewed as useful in facilitating adherence discussions between clinicians and patients. Conclusions This narrative review demonstrates that the use of digital pill system is broadly feasible across multiple disease states including human immunodeficiency virus, hepatitis C infection, solid organ transplants, tuberculosis, schizophrenia, cardiovascular disease, and acute fractures, where adherence is closely linked to significant morbidity and mortality. It also highlights key areas of research that are still needed prior to broad-scale clinical deployment of such systems.

Using chronobiology-based second-generation artificial intelligence digital system for overcoming antimicrobial drug resistance in chronic infections

“…A novel platform comprises ingestible sensors implanted in medications for TB, HCV, HIV, and other medical conditions where adherence is crucial to avoid significant morbidity and mortality [ 62 ]. Upon ingestion, the sensor interacts with the patient’s gastric fluid sending a signal transmitted to a monitor adhered to the patient’s skin, which sends a signal to the patient’s smartphone allowing sharing of the information with the patient’s physician.…”

Formative acceptance of ingestible biosensors to measure adherence to TB medications: An exploratory study

“…Previous investigations have demonstrated the feasibility of utilizing a DPS to measure medication adherence in the context of multiple disease states, including hepatitis C, hypertension, and HIV pre-exposure prophylaxis. [13] Prior studies conducted among TB patients in the US have demonstrated high DPS accuracy in detecting ingestion events and user acceptance of the technology. [14,15] Despite the demonstrated feasibility of DPS technology, however, it remains unclear whether the DPS can be implemented for ATT adherence monitoring in India, given key differences in the cultural context of adherence monitoring, availability of smartphone infrastructure, and a lack of documented perspectives of key stakeholders surrounding patient privacy in the context of TB and ATT.…”

Bibliometric analysis and evidence of clinical efficacy and safety of digital pills

“…Chai et al systematized 18 pilot clinical trials of digital pills in the treatment of HIV, hepatitis C, solid organ transplantation, tuberculosis, schizophrenia, cardiovascular disease, and acute fractures ( Chai et al, 2022 ). Studies typically included up to 50 patients, some between 120 and 288 individuals, and they lasted from 1 week to 6 months.…”