5 Digital Tools for Improving Medication Adherence

As technological innovations continue to transform health care, many pharmacists and other providers are increasingly looking to digital solutions for improving medication adherence among their patients.

During a session at the 2018 American Society of Health-Systems Pharmacists (ASHP) Midyear Clinical Meeting, Timothy Aungst, PharmD, an associate professor at the MCPHS University School of Pharmacy and contributing writer for Pharmacy Times, discussed the approaches taken to increase adherence in the smart phone era. Acknowledging the multifactorial nature of nonadherence, Dr. Aungst noted that low-tech devices—including digital timer caps, and simple pillboxes—failed to yield significant improvements in clinical trials.

Given the ubiquity of smart phones, tech companies have created a variety of digital devices and platforms aimed at boosting adherence. Several of those highlighted by Dr. Aungst in his session include:

1. Mobile medical apps. Serving as a “digital medical hub” for user, mobile apps alert patients when to take their medications while allowing them to record their history. The major draw of these apps is their cost-effectiveness: most apps are free, though some will collect data for resale. Many apps also encourage adherence through the use of gamification and metrics.

However, most apps are standalone software, and have little integration into a larger platform. Additionally, patients who mark that the app’s alerts may not have necessarily taken their medication, making it difficult to track absolute adherence.

Although there is little literature on the effectiveness of medical apps in improving adherence, one study found a small improvement in self-blood pressure monitoring among patients with hypertension who used an app.

2. Smart pill bottles. These devices can track when patients take their medications through sensors in a cap that detect when a bottle is open, or through sensors in the bottle itself that determine the weight of the remaining pills. Smart bottles can be used without an app or other technology, and they can be added to a patient’s preexisting framework.

For patients who take multiple medications, however, the cost of theses bottles can quickly add up, and although these device can track when a pill is removed, they cannot track whether the medication was taken.

In one study, researchers noted an increase in self-reported adherence among patients who used smart pill bottles but no comparable change in therapeutic levels.

3. Smart package systems. High-tech versions of blister and strip packaging, smart package devices serve as reminders for patients and provide tracking of dispensed doses. Smart package systems are particularly useful for patients with multiple medications, and they can integrate with drugs packaged by a pharmacy.

Because smart package systems are larger, they can be very expensive, but they have the potential to serve as a “one-stop” device. As with smart pill bottles, they can only track if a pill was removed, not if it was taken.

A study in which patients were given smart pill trays and counseled by a health coach found increased adherence levels among these patients but no difference in drug concentration; furthermore, it remained unclear whether the boost in adherence was due to the devices’ use or to the health coach’s involvement.

4. Smart pill dispensers. Playfully described by Dr. Aungst as the offspring of the above technology and Amazon’s Alexa, these device incorporate home voice assistants, remote access to health care professionals, and other activation features while dispensing medication.

As with smart package systems, smart pill dispensers can be very expensive, but likewise can meet a variety of patient needs. These devices also face the same difficulty in tracking absolute adherence.

5. Bioingestible sensors. These devices are embedded onto an oral drug that, when dissolved, sends an alert to a patient’s smart phone and later physician via a wearable patch indicating that the patient has taken his or her medication. The first FDA-approved drug with a bioingestible sensor, Abilify Mycate, received the agency’s nod in November 2017.

Although bioingestible sensors can track adherence, they do not themselves improve adherence. Given the novelty of these devices, their average cost to consumers remains uncertain.

Dr. Aungst suggested that digital technology could prove a key tool in improving medication adherence and collecting objective, real-time data, though he emphasized that much more work and innovation is needed to make that potential a reality.

“Digital health presents a novel means of assessing and potentially improving medication adherence through multiple interventions,” he concluded. “However, a current focus on an ‘all-in-one’ solution platform has not led to promising clinical results at this time.”

Reference

Aungst T. From Pillboxes to Smart Pills: How Digital Health is Changing Medication Adherence. Presented at: 2018 ASHP Midyear Clinical Meeting. December 2-6, 2018. Anaheim, California.