Boston— “I forgot” is one of the most common responses when patients are asked why they aren’t adherent to chronic disease medications, notes a new study that sought to determine if the issue could be addressed with medication-reminder devices.

Results were disappointing, however, notes a report in JAMA Internal Medicine. Three low-cost reminder devices didn’t improve patients’ compliance with the medication regimes.

To determine that, a study team led by Brigham and Women’s Hospital and Harvard Medical School researchers conducted a four-arm, block-randomized clinical trial involving 53,480 enrollees of CVS Caremark, a pharmacy benefit manager, across the U.S.

Included were 53,480 eligible participants, 18 to 64 years, 56% female, who were prescribed one to three oral medications for long-term use. Participants were determined to have been suboptimally adherent to all of their prescribed therapies—with a medication-possession ratio of 30% to 80%—in the 12 months before randomization.

The cohort was further stratified by the medications they were using—for cardiovascular or other nondepression chronic conditions, labeled “the chronic disease stratum”; and antidepressants, labeled “the antidepressant stratum.”

In the study, conducted from February 2013 to March 2015, some patients received in the mail either a pill-bottle strip with toggles, a digital timer cap, or a standard pillbox, while the control group received neither notifications nor devices.

Pharmacy claims data was used to determine the primary outcome of optimal adherence, defined as a medication-possession ratio of 80% or greater, to all eligible medications among patients in the chronic disease stratum during 12 months of follow-up. The secondary outcomes included optimal adherence to cardiovascular medications among patients in the chronic disease stratum, as well as optimal adherence to antidepressants in the other group.

Results indicate that 15.5% of patients in the chronic disease stratum assigned to the standard pillbox, 15.1% assigned to the digital timer cap, 16.3% assigned to the pill- bottle strip with toggles, and 15.1% assigned to the control arm were optimally adherent to their prescribed treatments during follow-up.

“None of the devices differed substantially from the control arm with respect to optimal adherence to cardiovascular medications or antidepressants,” study authors explain. “In direct comparisons, patients randomized to the pillbox arm had a 14% higher odds of optimal adherence to antidepressants than patients randomized to the digital timer cap arm (OR, 1.14; 95% CI, 1.02-1.29) No statistically significant difference in the odds of optimal adherence between the control and any of the devices—standard pillbox: odds ratio [OR],?1.03; digital timer cap: OR,?1.00, and pill bottle strip with toggles: OR, 0.94 – were detected.”

They added, however, “In direct comparisons, the odds of optimal adherence were higher with a standard pillbox than with the pill bottle strip (OR, 1.10), with secondary analyses yielding similar results.”

The researchers called for future research on effective targeting of interventions and strategies that ensure sustained medication use and suggested, “The devices may have been more effective if coupled with interventions to ensure consistent use or if targeted to individuals with an even higher risk of nonadherence.”

« Click here to return to Weekly News Update.