Medication Adherence Feedback Research Articles

Patients' perspectives on feedback interventions to support adherence to long-term medication: a systematic review with thematic synthesis of qualitative evidence

Abstract Background Medication optimisation is a global issue with up to 50% of people not taking medicines as prescribed. Numerous interventions have been developed to address this, many of them including feedback on behaviour and outcomes. Understanding patients’ views on such interventions is essential for successful adoption and use. Purpose The purpose of this systematic review is to: (1) Understand patients’ perspectives and experiences of medication adherence feedback interventions and (2) Identify barriers and facilitators which influence their implementation within practice. Methods CINAHL, MEDLINE, EMBASE, PubMED, PsycINFO and Google Scholar were systematically searched to identify relevant studies. The inclusion criteria included; studies with qualitative or mixed method designs describing patients’ perspectives on medication adherence feedback interventions, primary studies with adult participants on long-term medications and studies involving interventions suitable for self-management in primary or community care. Quality assessment was completed using the Mixed Methods Appraisal Tool. The review was reported using the PRISMA and conducted using ENTREQ guidelines. Data were extracted and analysed using thematic synthesis (NVivo 20). Findings were presented narratively. Results From the 1,031 records screened, ten studies were included. Five studies were conducted in the United States, two in the United Kingdom, and one in the Netherlands, Canada, and Tanzania, respectively. Medication adherence interventions included the use of therapeutic drug monitoring methods and digital adherence technologies such as mHealth and eHealth for people living with asthma, HIV, coronary heart disease, hypertension, and type 2 diabetes. Patients found interventions acceptable if they were simple to use, allowed control over data sharing options, incorporated audio visual cues, and provided emotional and motivational support. Building trust between patients and healthcare providers and the resulting benefit of shared decision-making were also considered key factors for intervention success. However, developing interventions without user input was identified as a potential barrier to intervention implementation. Patients expressed an overall desire to have interventions tailored to meet their personal needs and preferences, highlighting the importance of placing user needs at the centre of intervention development. Conclusion Placing user needs at the centre of adherence intervention development is crucial for successful implementation. Further research which facilitates user involvement in co-designing interventions to compliment patients’ characteristics and preferences would be key for intervention implementation.

Text Messaging May Engage and Benefit Adults with Type 2 Diabetes Regardless of Health Literacy Status.

Background:Technology-delivered interventions have the potential to improve diabetes self-care and glycemic control among adults with type 2 diabetes (T2D). However, patients who do not engage with interventions may not reap benefits, and there is little evidence on how engagement with mobile health interventions varies by health literacy status.Objective:This study explored how patients with limited health literacy engaged with and experienced Rapid Education/Encouragement and Communications for Health (REACH), a text messaging intervention designed to support the self-care adherence of disadvantaged patients with T2D. We recruited adults with T2D from federally qualified health centers and used mixed methods to examine (1) associations between users' health literacy status and their prior mobile phone use and their engagement with REACH and (2) similarities and differences in users' self-reported benefits by health literacy status.Methods:Participants (N = 55) completed a survey, including measures of health literacy and prior mobile phone use. For 2 weeks, participants experienced REACH, which included daily text messages promoting self-care and asking about medication adherence, and weekly text messages providing medication adherence feedback. After 2 weeks, participants completed a semi-structured telephone interview about their experiences.Key Results:Participants with limited health literacy were less likely to have used cell phones to access the Internet (48% vs. 90%, p = .001) or email (36% vs. 87%, p < .001), but equally as likely to have used text messaging and to respond to REACH text messages (p = .12 and p = .40, respectively) compared to participants with adequate health literacy. Participants responded to 93% of text messages on average and reported benefits of the intervention, including reminders and accountability, convenience and accessibility, and information and motivation. Participants with limited health literacy described a unique benefit of receiving social support from the intervention.Conclusions:Text messaging interventions may engage and benefit patients with T2D, regardless of health literacy status. Text messaging may have the potential to reduce T2D health disparities related to limited health literacy. [Health Literacy Research and Practice. 2017;1(4):e192–e202.]Plain Language Summary:Limited health literacy is associated with less engagement with health information technology, but there is little evidence on how engagement with text messaging interventions varies by health literacy status. This intervention engaged and benefited adults with type 2 diabetes in safety-net clinics, regardless of health literacy status. Participants with limited health literacy described a unique intervention benefit of social support.

Direct Adherence Measurement Using an Ingestible Sensor Compared With Self-Reporting in High-Risk Cardiovascular Disease Patients Who Knew They Were Being Measured: A Prospective Intervention.

BackgroundUse of appropriate cardioprotective medication is a cornerstone of cardiovascular disease prevention, but less-than-optimal patient adherence is common. Thus, strategies for improving adherence are recommended to adopt a multifaceted approach.ObjectiveThe objective of our study was to test a system comprising a biodegradable, ingestible sensor for direct measurement of medication ingestion in a group of patients at elevated cardiovascular risk attending a cardiac prevention and rehabilitation program.MethodsIn this prospective intervention trial in a single group of 21 patients running from April 2014 to June 2015, we measured adherence by self-report and adherence determined objectively by the system. The sensor emits a signal when it encounters the acidic environment of the stomach, detectable by an externally worn patch and linked software app. Longitudinal adherence data in the form of daily progress charts for sensed dosing events as compared with scheduled dosing are visible to patients on their tablet computer’s medication dosing app, thus providing patients with continuous medication adherence feedback. We sought feedback on patient acceptability by questionnaire assessment. Participants used the system for the 12-week period of their cardiac prevention and rehabilitation program.ResultsOnly 1 patient at initial assessment and 1 patient at end-of-program assessment reported often missing medication. The remaining patients reported never missing medication or had missing data. Only 12 (57%) of patients overall achieved system-determined adherence of 80% or more, and 3 patients had scores below 40%. Participants reported high levels of acceptability.ConclusionsThis integrated system was well tolerated in a group of 21 patients over an appreciable time frame. Its ability to measure adherence reveals the sizeable disconnect between patient self-reported adherence and actual medication taking and has promising potential for clinical use as a tool to encourage better medication-taking behavior due to its ability to provide continuous patient-level feedback.

Patient and Partner Feedback Reports to Improve Statin Medication Adherence: A Randomized Control Trial.

Simple nudges such as reminders and feedback reports to either a patient or a partner may facilitate improved medication adherence. 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. Three-month, three-arm randomized clinical trial (ClinicalTrials.gov identifier: NCT02480530). One hundred and twenty-six veterans with known coronary artery disease and poor adherence (medication possession ratio <80%). 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 3months, and participants were followed for an additional 3months after the intervention period. Adherence as measured by pill bottle. Secondary outcomes included change in LDL (mg/dl), patient activation, and social support. 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 6months, 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.

Medication adherence feedback intervention predicts improved human immunodeficiency virus clinical markers

Thirty-three participants in a human immunodeficiency virus (HIV) medication adherence feedback (MAF) intervention were compared with 58 HIV-positive non-participants in laboratory-tested CD4 and viral load. The intervention provided adherence feedback and counselling based on a visual display from an electronic pill bottle (MEMS(TM) ). Multiple regression controlling for baseline CD4 and showed that postintervention CD4 was higher for MAF participants than for non-MAF participants. Non-MAF participants' CD4 significantly declined over time. MAF participants were also less likely than non-MAF participants to have a detectable postintervention viral load.

Adherence Feedback to Improve Asthma Outcomes Among Inner-City Children: A Randomized Trial

We evaluated the longitudinal effects of home-based asthma education combined with medication adherence feedback (adherence monitoring with feedback [AMF]) and asthma education alone (asthma basic care [ABC]) on asthma outcomes, relative to a usual-care (UC) control group. A total of 250 inner-city children with asthma (mean age: 7 years; 62% male; 98% black) were recruited from a pediatric emergency department (ED). Health-outcome measures included caregiver-frequency of asthma symptoms, ED visits, hospitalizations, and courses of oral corticosteroids at baseline and 6-, 12-, and 18-month assessments. Adherence measures included caregiver-reported adherence to inhaled corticosteroid (ICS) therapy and pharmacy records of ICS refills. Multilevel modeling was used to examine the differential effects of AMF and ABC compared with UC. ED visits decreased more rapidly for the AMF group than for the UC group, but no difference was found between the ABC and UC groups. The AMF intervention led to short-term improvements in ICS adherence during the active-intervention phase relative to UC, but this improvement decreased over time. Asthma symptoms and courses of corticosteroids decreased more rapidly for the ABC group than for the UC group. Hospitalization rates did not differ between either intervention group and the UC group. No differences were found between the ABC and AMF groups on any outcome. Asthma education led to improved adherence and decreased morbidity compared with UC. Home-based educational interventions may lead to modest short-term improvements in asthma outcomes among inner-city children. Adherence feedback did not improve outcomes over education alone.