Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Do Reminder Devices Aid in Medication Adherence?

JAMA Intern Med; ePub 2017 Feb 27; Choudhry, et al

Publish date:

Medication adherence among nonadherent patients who were taking up to 3 medications to treat common chronic conditions was not improved with the use of low-cost reminder devices, a recent study found. The 4-arm, block-randomized trial included 53,480 participants aged 18 to 64 years and taking 1 to 3 oral medications for long-term use. Patients were suboptimally adherent to all of their prescribed therapies in the 12 months before randomization and were stratified on the basis of medications used at randomization: medications for cardiovascular or other nondepression chronic conditions (the chronic disease stratum) and antidepressants (the antidepressant stratum). The control group received neither notification nor a device. Researchers found:

  • In primary analysis, 15.5% of patients in the chronic disease stratum assigned to the standard pillbox, 15.1% assigned to the digital timer cap, 16.3% assigned to the pill box strip with toggles, and 15.1% assigned to the control arm were optimally adherent to their prescribed treatments during follow-up.
  • There was no statistically significant different odds of optimal adherence between the control and any of the devices.
  • Optimal adherence odds were higher with a standard pillbox than with the pill bottle strip.

The authors concluded that the devices may be more effective if coupled with interventions to ensure consistent use.

Citation:

Choudhry NK, Krumme AA, Ercole PM, et al. Effect of reminder devices on medication adherence. The REMIND randomized clinical trial. [Published online ahead of print February 27, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2016.9627.

Commentary:

The act of taking medications is influenced by many factors that come together at a point in time when the patient is not directly engaged with the health care system. It is at that moment that patients remember and decide to take their medications or they do not take their medications. The factors that influence medication adherence are complex and include financial, educational, motivational, and practical issues. Numerous studies show that individuals often do not take their medicines as prescribed.¹ ² Adherence rates for medications for chronic disease show that patients on average take only about 50% of prescribed doses. For patients with diabetes, the average adherence rate is about 70%, with rates ranging in different studies from 31%-87%. Poor medication adherence can lead to poorer clinical outcomes, including increased hospitalizations.3 The study reviewed above shows that poor adherence is caused by more than just forgetfulness, and any answer to the problem of adherence will have to be as complex as the problem itself, including ways to address understanding, finances and motivation, as well as forgetting to take medications. For those of us in primary care, this is a nice reminder to ask about mediation adherence as a first step when patients do not achieve control as a part of chronic disease management, and then doing what we can in the office to facilitate understanding of the importance of taking medications and helping to motivate patients to achieve their goals. —Neil Skolnik, MD

  1. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487-497. doi:10.1056/NEJMra050100.
  2. Cutler D, Everett W. Thinking outside the pillbox—medication adherence as a priority for health care reform. N Engl J Med. 2010;362:1553-55. doi:10.1056/NEJMp1002305.
  3. Sokol MC, McGuigan KA, Verbrugge RR, et al. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005;43:521e30.

This Week's Must Reads

Must Reads in Preventive Care