A Pilot Study to Evaluate the Acceptability of Using a Smart Pillbox to Enhance Medication Adherence Among Primary Care Patients.

Choi Choi

doi:10.3390/ijerph16203964

Abstract

Smart pillboxes that remind patients to take medication may help avoid unintended non-adherence to medication regimens. To better understand the implementation potential of smart pillboxes among patients with chronic diseases, this study aimed to explore patients’ acceptability to use such devices and its associated factors. Five-hundred primary care patients aged 40 years or older were randomly recruited from a government-funded primary care clinic in Hong Kong. Patients were asked (i) if they needed to take medication daily, (ii) how many daily oral medications they needed to take on average, (iii) if they had ever missed a dose by accident, and (iv) if they were willing to use a smart pillbox for free to remind them to take medication. Out of the 344 participants included in the analysis who needed to take daily oral medication, 49.1% reported having previously missed a dose by accident, and 70.6% were willing to use a smart pillbox for free. A multiple logistic regression model found that male patients (adjusted odds ratio (aOR): 0.59) and patients with hypertension (aOR: 0.56) were less likely to have previously missed a dose by accident. Patients who needed to take a greater number of daily medications (aOR: 1.16), who had previously missed a dose by accident (aOR: 2.44), with heart disease (aOR: 3.67) and with a high monthly income (aOR: 2.30) were more willing to use a smart pillbox, while older patients (aOR: 0.95) were less willing to do so. Primary care patients who reported missing a dose by accident were 2.4 times as likely to want to use a smart pillbox while those with heart disease were almost 4 times as likely to want to use a smart pillbox. Further studies such as those evaluating the willingness to pay for smart pillboxes and randomised control trials to evaluate the effectiveness of smart pillboxes in enhancing medication adherence should be conducted to provide more evidence about the implementation potential of such devices.

Highlights

It is estimated that approximately one in three Chinese adults in Hong Kong have chronic diseases such as hypertension, diabetes and heart disease, with 59% of those being less than 60 years old [1]
Non-adherence can lead to adverse outcomes such as failure to control blood pressure among patients with hypertension [2], increased risk of mortality in diabetes patients [3] and greater risk of cardiovascular mortality among patients with coronary artery disease [4]
Socio-demographic factors, three highly prevalent chronic diseases and the number of daily oral medications that patients needed to take were included in the regression model to explore factors associated with having missed a dose

Summary

Introduction

It is estimated that approximately one in three Chinese adults in Hong Kong have chronic diseases such as hypertension, diabetes and heart disease, with 59% of those being less than 60 years old [1]. The treatment of such diseases commonly includes the long-term use of medication. Adherence to medication regimens according to the recommendations of patients’ clinicians is of paramount importance in ensuring optimal patient outcomes. Non-adherence can be intentional (i.e., an active decision on the part of patients to eschew prescribed treatments) or unintentional (i.e., a passive process whereby patients fail to adhere to the regimen through forgetfulness or carelessness) [5]. A study in the United States found that in the preceding six months 62.4% of participants

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