The effect of electronic monitoring feedback on medication adherence and clinical outcomes: A systematic review

Abstract

ObjectiveThis study aims to assess the efficacy of Electronic Monitoring Feedback (EMF) as an intervention to improve medication adherence (i.e. dose- or full adherence) and clinical outcomes in adult patients.MethodsA systematic search was performed in Medline, EMBASE, PsycINFO and Web of Science and reported according to the PRISMA guidelines. Randomised controlled trials (RCTs) comparing EMF with usual care were identified to systematically summarise the evidence for use of EMF in improving medication adherence and clinical outcomes. The GRADE approach was used to assess the quality of the body of evidence.ResultsOf 9,993 initially-identified studies, ten studies (four of high-quality and six of low-quality) were included. The sample size of the studies included varied from 18 to 205 patients. Four of the six studies (66.7%) reported a significant positive effect of EMF on mean dose adherence levels, whereas a significant positive effect of EMF on mean full adherence levels was found in all of the included studies (100%, five out of five of the studies included). A significant positive effect of EMF on clinical outcomes was reported in one of the seven studies included. The overall effect of EMF on mean dose- and full adherence was positive and the overall effect of EMF on clinical outcomes was inconclusive.ConclusionConsidering the positive effect of EMF on medication adherence, EMF might be a promising intervention to enhance medication adherence. However, the effect of EMF on clinical outcomes was inconclusive. Prior to implementing EMF in clinical practice, future research with high-quality studies (e.g. adequate sample sizes, follow-up periods and no interfering co-interventions) is required to examine the (long-term) efficacy of EMF.

A Review of Medication Adherence Monitoring Technologies

“…Medication adherence can be defined as the extent to which a person-taking medication adheres to a self-administered protocol [8,20,21]. In other words, medication adherence refers to the medication-intake behavior of the patient conforming to an agreed medication regimen specified by the healthcare provider with respect to timing, dosage, and frequency [22,23]. From another point of view, non-adherence refers to the failure of taking medication as prescribed, including in-consistency, missing doses, and failing to re-fill the medication.…”

“…The benefits of adhering to medication regimens are many. However, for the patient, high adherence to prescribed medication leads to less health complications, more treatments' benefits, and potentially active drug effect in the case of completely treated infectious disease [22]. Another benefit is that medication adherence helps in minimizing drug wastage and reducing healthcare costs [26].…”

“…Full adherence to medication is required as the drug can be effective only when it is taken [22]. Nonetheless, maintaining strict medication adherence is required that deems maintaining administration timing, dosage quantity, and frequency [28].…”

Electronic Pill Bottles or Bidirectional Text Messaging to Improve Hypertension Medication Adherence (Way 2 Text): a Randomized Clinical Trial

“…The primary form of motivation was provided through frequent feedback and alerts, which has been shown to increase participation in other studies, although the primary outcomes were measures of medication adherence and not clinical outcomes. 17,37 However, there is an opportunity to leverage additional insights from behavioral science such as social influence, financial incentives, and manipulations of choice architecture. 18,[38][39][40][41] For example, friends or family members could be engaged to encourage adherence or medications could be provided to patients automatically as the default.…”

Capsule Commentary: Mehta et al. Electronic Pill Bottles or Bidirectional Text Messaging to Improve Hypertension Medication Adherence

“…Furthermore, Mehta and colleagues are not alone in achieving apparent improvements in adherence but not in clinical outcomes. 2,5 What to do? While the participants' high recommendations of both technologies (9 out of 10) should encourage us not to abandon technology, the answer to improving blood pressure control is likely to be more intensive interactions between patients and clinicians.…”