Monday, February 27, 2017

Low-Cost Reminder Devices May Not Improve Medication Adherence

Low-cost approaches that remind patients to take their medications may not be enough to improve medication adherence in people with chronic conditions, according to a study published today in JAMA Internal Medicine.

Niteesh Choudhry, M.D., Ph.D., of Brigham and Women’s Hospital in Boston and colleagues enrolled nearly 54,000 participants (including 16,000 patients taking antidepressants) in the Randomized Evaluation to Measure Improvements in Nonadherence (REMIND) trial to evaluate one of three low-cost adherence devices: a pill bottle with seven affixed toggles that can be slid after each daily dose is taken, a pill bottle cap with a digital timer displaying elapsed time since medication was last taken, or a standard pillbox with seven separate compartments.

The patients were all chosen based on a prescription history of suboptimal adherence (defined as a medication possession ratio between 30% and 80%) and randomized to receive one of the three devices in the mail (along with instructions and a number to call for assistance); patients in the control group did not receive any devices. Over 12 months, the researchers measured medication adherence using pharmacy refill data (with a medication possession ratio of 80% or more being considered adherent).

They found no discernible difference between any of the interventions and controls, both for the larger patient cohort and subgroups taking either cardiovascular drugs or antidepressants. In each study arm, about 15% of participants became adherent within one year of receiving their intervention.

The authors stated that is possible that these three devices simply may not work, but cautioned that other factors could affect the results. For example, they noted that as part of a pragmatic approach (echoing real-world practice), the device mailings were not coordinated with medication refills; patients may therefore have had difficulty transitioning to the device in the middle of a prescription fill.

“[F]or patients without established routines around medication taking, the additional cues from these devices may not be sufficient to overcome forgetfulness,” the authors wrote. “Moreover, the devices may not have promoted periodic medication refilling, which is necessary for long-term adherence. For these devices to work, they may need to be administered with additional support mechanisms.”

In an accompanying editorial, Ian Kronish, M.D., M.P.H., and Nathalie Moise, M.D., of Columbia University described the challenges of medication nonadherence and several strategies to improve adherence. 

“Innovations in e-prescribing have made it possible to leverage pharmacy fill data such that clinicians can identify nonadherent patients at the point of care. Targeting intensive behavioral adherence interventions at high-risk nonadherent patients may be an approach to achieving value,” they wrote. “When nonadherence is suspected, clinicians are encouraged to explore the reasons for nonadherence and to incorporate behavior-change techniques from effective, multicomponent interventions into their practice. These techniques may include providing feedback on self-monitoring, enlisting social supports, and recommending use of reminder systems.” 

To read about other strategies to promote medication adherence, see the Psychiatric News article “Independent Living May Improve Adherence When Combined With ACT.”

(Image: Paul Matthew Photography/Shutterstock)


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