Abstract
BackgroundMedication adherence is challenging for older adults due to factors such as the number of medications, dosing schedule, and the duration of drug therapy. The objective of this study was to examine the effectiveness of an in-home electronic medication dispensing system (MDS) on improving medication adherence and health perception in older adults with chronic conditions.MethodsA pilot Randomized Controlled Trial (RCT) was conducted using a two-arm parallel assignment model. The intervention group used an MDS as their medication management method. The control group continued to use their current methods of medication management. Block randomization was used to assign participants into the intervention or control group. The inclusion criteria included 1) English speaking 2) age 50 and over 3) diagnosed with one or more chronic condition(s) 4) currently taking five or more oral medications 5) City of Calgary resident. Participants were recruited from a primary care clinic in Alberta, Canada. The study was open-label where knowledge about group assigned to participants after randomization was not withheld. Medication adherence was captured over a continuous, six-month period and analyzed using Intention-to-Treat (ITT) analysis.ResultsA total of 91 participants were assessed for eligibility and 50 were randomized into the two groups. The number of participants analyzed for ITT was 23 and 25 in the intervention and control group, respectively. Most of the demographic characteristics were comparable in the two groups except the mean age of the intervention group, which was higher compared to the control group (63.96 ± 7.86 versus 59.52 ± 5.93, p-value = 0.03). The average recorded adherence over 26 weeks was significantly higher in the intervention group than the control group (98.35% ± 2.15% versus 91.17% ± 9.76%, p < 0.01). The self-rated medication adherence in the intervention group also showed a significant increase from baseline to 6-month (Z=-2.65, p < 0.01). The control group showed a non-significant increase (Z=-1.79, p = 0.07).ConclusionThe MDS can be an effective, long-term solution to medication non-adherence in older adults experiencing chronic conditions and taking multiple medications. The technology induces better consistency and improvement in medication taking behaviour than simple, non-technological intervention.Trial registrationRegistered with ClinicalTrials.gov on April 09, 2020 with identifier NCT04339296.
Highlights
Medication adherence is challenging for older adults due to factors such as the number of medications, dosing schedule, and the duration of drug therapy
The prescription of multiple medications and complex medication regimens are common among older adults to treat and prevent complications associated with chronic diseases
No statistically significant difference was found between the two groups on most characteristics (p-value> 0.05); the mean age of the intervention group was higher compared to the control group (63.96 ± 7.86 versus 59.52 ± 5.93, p-value = 0.03)
Summary
Medication adherence is challenging for older adults due to factors such as the number of medications, dosing schedule, and the duration of drug therapy. The objective of this study was to examine the effectiveness of an in-home electronic medication dispensing system (MDS) on improving medication adherence and health perception in older adults with chronic conditions. The prescription of multiple medications and complex medication regimens are common among older adults to treat and prevent complications associated with chronic diseases. In Canada and the United States, 31 and 35% of older adults aged 60–79 use five or more prescription drugs, respectively [2]. Medication adherence is challenging for older adults due to medication regimen factors, such as the number of medications, dosing schedule, and the duration of drug therapy [4]
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