Technologies for Monitoring Medication Adherence: Important Aspects to Consider for Technology Assessment (Preprint)

BACKGROUND Accurately measuring and monitoring patient medication adherence is a global challenge due to the absence of “gold standard” methods for adherence measurement. Recent attentions have turned towards the adoption of technologies for medication adherence monitoring as they provide the opportunity for continuous tracking of individual medication adherence behavior. Yet, current medication adherence monitoring technologies vary by their technical features and methods of adherence data capture, leading to differences in their respective advantages and limitations. Overall, there is a lack of appropriate criteria to guide the assessment of medication adherence monitoring technologies for optimal adoption and utilization. OBJECTIVE This study aimed to provide a concise overview and summary of current medication adherence monitoring technologies and propose a set of technology assessment criteria to aid in the development and adoption of these technologies. METHODS A literature search was conducted on PubMed, Scopus, CINAHL, and ProQuest Technology Collection (January 2010-June 2021) using the combination of keywords "medication adherence," "measurement technology," and "monitoring technology". The selection focused on studies related to medication adherence monitoring technology and its development and use. The technological features, methods of adherence data capture, and potential advantages and limitations of identified technology applications were extracted. Common, recurring elements were synthesized as potential technology assessment criteria. RESULTS Among 3865 articles retrieved, 98 remained for final review, which reported a variety of technology applications for monitoring medication adherence, including electronic pill bottles/boxes, ingestible sensors, electronic medication management systems, blister pack technology, patient self-report technology, video-based technology, and motion-sensor technology. The most commonly reported technologies included electronic pill bottles, electronic pillboxes, and ingestible sensors. Twenty-eight technology assessment criteria were identified and organized into five categories: Development Information, Technology Features, Medication Adherence Data Collection & Management, Feasibility & Implementation, and Acceptability and Usability. CONCLUSIONS This study summarized the technical features, data capture methods, and various advantages and limitations of medication adherence monitoring technology reported in the literature and proposed criteria for assessing medication adherence monitoring technologies. This collection of assessment criteria may be a useful tool to guide the development and selection of relevant technology, facilitating the optimal adoption and effective use of technology to improve medication adherence outcomes. Future studies are suggested to further validate the medication adherence monitoring technology assessment criteria and construct an appropriate technology evaluation framework.

A SYSTEMATIC REVIEW ON SELF-REPORTED QUESTIONNAIRES TO ASSESS MEDICATION ADHERENCE IN DIABETIC PATIENTS

Adherence to pharmacological therapies are keys to effective treatments in diabetic patients. Previous reviews found that most adherence measurement studies on chronic diseases used a self-reported scale. However, there is no consensus on the best scale to measure adherence in diabetic patients. The purpose of this systematic review was to identify the potential self-reported scale that could be considered for measuring medication adherence in diabetic patients and to provide recommendations for researchers or clinicians to determine appropriate adherence self-reported scales in diabetic patients. This review follows general guidelines in the implementation of systematic reviews. After further review, it was found that 33 studies met all inclusion criteria from 4 databases (Wiley, Science Direct, Scopus, and PubMed). The articles were done by the PRISMA, while the keywords were determined by the PICO method. Most research was conducted in Asia (69.7%) and America (18.2%) on patients with type 2 diabetes (81.3%), patients in hospitals (54.5%), suffering for 1–6 months (54.5%), and using a cross-sectional study design (78.8%). HbA1c clinic data (57.6%) were used in most studies as biological markers of adherence. The measurement scales of medication adherence in diabetic patients are MMAS-8 (57,.5%), MMAS-4 (12.1%), BMQ (9%), MCQ (6%), ARMS (3%), ARMS-D (3%), GMAS (3%), LMAS-14 (3%), and MARS-5 (3%). This review provides information on the different self-reported scales most widely used in diabetic medication adherence research. Various aspects need to be considered before choosing the scale of adherence.

A Novel Digital Pill System for Medication Adherence Measurement and Reporting: A Usability Validation Study (Preprint)

BACKGROUND Medication nonadherence is a costly problem that is common in clinical use and and clinical trials alike with significant adverse consequences. Digital pill systems have proven to be effective and safe solutions to the challenges of nonadherence, with documented success in improving adherence and health outcomes. OBJECTIVE This human factors validation study evaluated a novel digital pill system, the ID-CapTM System from etectRx, for usability among patient users in a simulated real-world use environment. METHODS Seventeen patients of diverse background who regularly take oral prescription medications were recruited. After training and a period of training decay, participants were asked to complete 12 patient use scenarios during which errors or difficulties were logged. Participants also were interviewed about their experience with the ID-Cap System. RESULTS In this human factors validation study, patient users completed 97% of the use scenarios successfully, and 75% of these were completed without any failures or errors. Participants found the ID-Cap System easy to use and were able to accurately and proficiently record ingestion events using the device. CONCLUSIONS Participants demonstrated the ability to safely and effectively use the ID-Cap System for its intended use. Regardless of age, educational level, or background, patients were able to use it successfully. The ID-Cap System has great potential as a useful tool for encouraging medication adherence and can be easily implemented by patient users. CLINICALTRIAL Not applicable

Inter-rater reliability of an exercise adherence measurement tool: Measurement Of adherence Via Exercise Demonstration (MOVED)

Objective: To explore the inter-rater reliability of the Measurement Of adherence Via Exercise Demonstration (MOVED) adherence tool. Design: Reliability study of a patient adherence measurement tool.Setting: Simulated physiotherapist-patient consultations. Participants: Sixteen experienced physiotherapists rated patient adherence to exercise. Interventions: N/A Main Outcome Measure: Inter-rater reliability of MOVED.Methods: The MOVED tool consists of two parts. Part one asks patients to self-report their adherence to exercise dose (including number of completed sessions, sets and repetitions in the last seven days). Part two asks patients to demonstrate each exercise. Component scores are totalled to give an overall level of patient adherence to each exercise.Participants were provided with a copy of five physiotherapist-prescribed exercises. Participants were then shown five corresponding video vignettes of simulated physiotherapist-patient consultations where patients were asked to self-report exercise frequency, sets and repetitions and demonstrate each exercise within the context of a consultation. Participants were asked to rate the level of patient adherence to each of the five exercises using the MOVED tool. Inter-rater reliability of MOVED scores was assessed using Intraclass Correlation Coefficient (ICC) and 95% Confidence Intervals. Results: The ICC of part one (self-report) was .90 (95%CI .74-.98), part two (demonstration) was .98 (95%CI .94-.99) and total score was .96 (95%CI .88-.99), demonstrating excellent inter-rater reliability. Conclusion: The MOVED tool, which can highlight whether patients are adhering to exercise technique as well as exercise dose, may provide clinicians and researchers with a more robust measure of exercise adherence when compared with other measures currently available.

The Effect of Self-reminder Card to the Level of Adherence of Hypertension Patients in Community Health Center in Surabaya

BACKGROUND: Hypertension was an increase of blood pressure which caused damages on the target organs. Treatment therapy of hypertension patients was very complex and required a long period of time. Target of hypertension therapy was to keep the patient’s blood pressure controlled. Achieved therapeutic target was increasing adherence of patient medication. The success of treatment was not only influenced by the quality of health care but also influenced by the patient’s adherence to the treatment. Self-reminder card was a tool helping patients to avoid forget taking medicine. AIM: The aim of this research was to determine the effect of self-reminder card on the level of adherence to treatment in hypertension patients in 10 community health centers (Puskesmas) in Surabaya. METHODS: This research used QUASI experimental two groups pre-post prospective. Adherence measurement used Morisky, Green, Levine Adherence Scale questionnaire. The results of the questionnaire were analyzed statistically. Research was conducted in May 2020 at the community health center in Surabaya. Research criteria are patients with hypertension diagnosis without comorbid disease who get antihypertensive therapy. RESULTS: The results of the study obtained 115 patients (55 control group patients and 60 intervention group patients). Statistical analysis using Mann–Whitney, there was a difference between the level of adherence to treatment in the control and intervention group with the value of p < 0.001. A test analysis using Wilcoxon signed-rank, there was a difference between the level of adherence to treatment before and after the intervention group with the value p < 0.001. CONCLUSIONS: Self-reminder card was effective in increasing the level of adherence to the treatment of hypertension patients.