Hypertension Adherence
Research Objectives:
This trial will evaluate the effect of communications technology, providing real-time information to patients, on adherence to medication. The aims of the trial are to increase drug adherence, to create and use a novel and automated feedback loop and to demonstrate patient satisfaction with this service.
Drivers:
Of the 65 million Americans with hypertension, almost 70% do not have adequate blood pressure control. A recent report by the World Health Organization stated that 50% of patients with chronic disease do not take the medication as prescribed. Poor adherence has a significant negative economic impact and leads to increasingly poor health outcomes for patients.
Program Overview:
This study uses consumer-grade technology to provide patients with feedback which we hypothesize will positively impact their adherence behavior. The study uses a “smart” pillbox that will send SMS messages to a central server housing the individual patient’s data. The data repository then signals back to the home device, in this case a simple globe, which gives the patient relevant feedback regarding whether medication has or has not been taken. Our team will examine the effect of unobtrusive and personalized reminders on adherence rates.
In addition to assessing whether or not the automated feedback system is technically feasible, this study will provide adherence data for the local hypertensive population, and is the first layer of a strategy to develop effective behavioral strategies to improve adherence.
This randomized controlled trial began in 2006 and recruited 70 patients.
Results:
The mean age of subjects within the intervention group was 54 (range 45-66). The majority were white, college-educated, employed full-time and comfortable using technology. All participants reported frequent non-adherence to their medications at the time of enrollment, despite high levels of health literacy and knowledge.
Prior to participating in the study, frequently reported reasons by subjects for non-adherence included forgetting to take medications, lacking an effective system to manage medications and feeling like they “didn’t need the medication anymore” and opting not to take it against medical advice.
Of the subjects in the intervention group that were surveyed, 65% of subjects felt this technology was effective in improving their adherence and 46% would enthusiastically recommend it to others. Other comments included:
“…the orb was a useful reminder that really got me into a firm routine - I’ve re-trained myself and can honestly say that I doubt I’ve skipped a dose in the past several months.”
“Participating in the trial caused me to become more responsible in taking my medication due to the overall accountability and trust.”
Although some users reported satisfaction with the reminder system, there were many suggestions for improvement and further investigation. Suggestions for technology improvements to enhance the value included better reliability, increased portability and addition of e-mail or cell phone reminders.
