Immunosuppression non-adherence increases the risk for kidney transplant loss after transplantation. Wireless-enabled pill bottles have created the opportunity to monitor medication adherence in real time. Reminders may help patients with poor memory or organization. Provision of adherence data to providers may motivate patients to improve adherence and help providers identify adherence barriers.
Intervention and Design
Kidney-transplant recipients were recruited to participate and were provided wireless pill bottles to store tacrolimus and record bottle openings.
Intervention - Participants were randomly assigned 1:1:1 to adherence monitoring with customized reminders (including alarms, texts, telephone calls, and/or e-mails), monitoring with customized reminders plus provider notification (every 2 weeks, providers received notification if adherence decreased to <90% during that period), or wireless pill bottle use alone (control).
Main Outcomes and Measures - The main outcome was bottle-measured tacrolimus adherence during the last 90 days of the 180-day trial. A secondary outcome was tacrolimus whole-blood concentrations at routine clinical visits.
Way to Health Use
Study Enrollment: Enroll and randomize participants in the study
Messaging Reminders: Send participants alerts and reminders through texts
Device Integration: Collect participant data from wireless pill bottle
Findings and Conclusions
Mean participant age was 50 years; 60% were men, and 40% were black. Mean adherence was 78%, 88%, and 55% in the reminders, reminders-plus-notification, and control arms (P < 0.001 for comparison of each intervention to control). Mean tacrolimus levels were not significantly different between groups.
Provider notification and customized reminders appear promising in helping patients achieve better medication adherence, but these strategies require evaluation in trials powered to detect differences in clinical outcomes.