Background and Aim
Simple nudges such as reminders and feedback reports to either a patient or a partner may facilitate improved medication adherence. The aim was to test the impact of a pill bottle used to monitor adherence, deliver a daily alarm, and generate weekly medication adherence feedback reports on statin adherence.
Intervention and Design
Three-month, three-arm randomized clinical trial. One hundred and twenty-six veterans with known coronary artery disease and poor adherence (medication possession ratio <80 %).
Intervention - Patients were randomized to one of three groups: (1) a control group (n = 36) that received a pill-monitoring device with no alarms or feedback; (2) an individual feedback group (n = 36) that received a daily alarm and a weekly medication adherence feedback report; and (3) a partner feedback group (n = 54) that received an alarm and a weekly feedback report that was shared with a friend, family member, or a peer. The intervention continued for 3 months, and participants were followed for an additional 3 months after the intervention period.
Main Measures and Outcomes - The primary outcome was medication adherence (daily opening of pill bottle) during the intervention period (13 weeks). Adherence was calculated as the number of days the GlowCap bottle was opened during the period divided by 91 (number of days in the time period). The secondary outcomes included adherence during the 13-week post-intervention period, change in the PAM and MSPSS (all assessed from baseline to 13 weeks and from 14 weeks to 26 weeks), and change in the LDL-direct level (from baseline to 26 weeks).
Way to Health Use
Study Enrollment: Enroll and randomize participants in the study
Device Integration: Collect participant data from wireless pill bottle
Support Partners: Provide participants with peer partners for reinforcement
Feedback Messaging: Automated-feedback messages to participants
Findings and Conclusions
During the 3-month intervention period, medication adherence was higher in both feedback arms than in the control arm (individual feedback group 89 %, partner feedback group 86 %, control group 67 %; p < 0.001 and = 0.001). At 6 months, there was no difference in medication adherence between either of the feedback groups and the control (individual feedback 60 %, partner feedback 52 %, control group 54 %; p = 0.75 and 0.97).
Daily alarms combined with individual or partner feedback reports improved statin medication adherence. While neither an individual feedback nor partner feedback strategy created a sustainable medication adherence habit, the intervention itself is relatively easy to implement and low cost.