Medication Reminder Devices Not Effective at Boosting Adherence, Study Finds

A study of 3 low-cost pill reminder devices found that their use did not meaningfully increase medication adherence among the patients who had received them.

One of the greatest challenges in managing chronic disease is ensuring that patients adhere to their medication regimens. Some interventions have focused on making it easier for patients to access their prescriptions; for example, a study in the most recent issue of The American Journal of Managed Care^® found that synchronized prescription refills were associated with improved adherence among patients taking multiple maintenance medications.

However, pharmacy benefit managers, insurers, and providers have shown interest in simpler, lower-cost strategies that could potentially achieve the same outcomes. In a study published recently in JAMA Internal Medicine, researchers set out to determine whether 3 simple medication reminder devices could improve adherence among patients who were enrollees of a pharmacy benefit manager.

The Randomized Evaluation to Measure Improvements in Nonadherence from Low-Cost Devices trial, aptly named REMIND, selected 36,739 patients on chronic disease treatment regimens and 15,555 patients taking antidepressants who had been suboptimally adherent prior to the study. The patients were stratified by regimen type (chronic disease or antidepressant) and were randomly assigned to either a control group or 1 of 3 reminder devices:

• A pill bottle with a strip of toggles that can be slid after each day’s dose has been taken
• A pill bottle cap with a digital timer displaying the time elapsed since the medication was last taken
• A plastic pillbox with 1 compartment for each day of the week

After 12 months, these interventions had negligible effects on medication adherence as measured by prescription claims. For instance, 15.1% of control patients in the chronic disease group became optimally adherent at follow-up, as did an identical proportion of patients who received the digital timer cap, 15.5% of patients in the daily pillbox arm, and 16.3% of patients who had used the toggled pill bottle.

However, some of these devices appeared to be more effective than others. The chronic disease patients who used the daily pillbox had 10% higher odds of achieving optimal adherence than those who had the toggled pill bottle. Among the patients taking antidepressants, the odds of optimal adherence were 14% higher for the patients in the pillbox arm compared with those who used the digital timer cap.

The researchers identified several possible reasons why adherence did not improve during the study, other than the simplest explanation that the devices were just not effective at reminding patients to take their medication. Patients may not have used the devices correctly, they often did not perceive their adherence as a problem, and the device distribution was not coordinated with their refill schedule, indicating that a single-pronged approach to correct forgetfulness may be insufficient. Instead, the study authors wrote, future interventions may see more success if they encompass multiple components of adherence.

“Trials are now being conducted to test ways to increase the efficiency of pharmacy-patient interactions, including delivering pharmacy services by telephone and linking these services to other resources, such as text messages and performance reports drawn from routinely collected administrative claims and electronic health record data,” they wrote. “Future research should focus on effective strategies to ensure uptake and sustained use of these interventions.”