February 27, 2017
Simple, low-cost medication reminder tools for long-term prescriptions appear to have no significant effect on adherence rates of patients with various chronic illnesses, according to data recently published in JAMA Internal Medicine.
“Suboptimal adherence to medications for chronic conditions, such as hypertension and diabetes, results in potentially avoidable morbidity, mortality and health care spending,” Niteesh K. Choudhry, MD, PhD, of Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote. “Small studies have found that … low-cost devices improve adherence to antiretroviral medications, but there are limited data about their ability to improve the quality of medication taking in other therapeutic areas, especially in real-world naturalistic settings.”
The researchers examined three low-cost adherence devices: a pill bottle with a daily toggle strip, a pill bottle cap with a digital timer, and a plastic pillbox with daily compartments. They assigned these to patients aged 18 to 64 years with prescriptions for cardiovascular disease, depression or another non-depression chronic condition.
Among the study’s 53,480 participants, Dr. Choudhry and colleagues reported optimal adherence among 15.5% of chronic disease patients assigned pillboxes, 15.5% of patients assigned digital timer caps, 16.3% of patients with pill bottle toggle strips and 15.1% of control patients. After analysis, they found no significant differences in the odds of optimal adherence between any devices and control, and no differences in secondary analyses of the cardiovascular and antidepressant groups.
With these results in mind, tackling the issue of suboptimal medication adherence will require greater efforts into nonadherence detection, budding technologies and clinician-patient engagement, according to Ian M. Kronish, MD, MPH, and Nathalie Moise, MD, MS, both of the Center for Behavioral Cardiovascular Health at Columbia University Medical Center.
“Adherence researchers and practicing clinicians need to acknowledge that there is unlikely to be a ‘magic pill’ that will solve medication nonadherence,” they wrote in an accompanying editorial. “Routinely inquiring about medication adherence in a nonjudgmental manner remains essential to uncovering nonadherence when objective measures are unavailable. 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.”