More studies needed for medication adherence?

By Brian Dolan
02:20 am
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Brian Dolan, Editor, MobiHealthNewsA study recently published in the journal Clinical Transplantation found that kidney transplant recipients improved their adherence to immunosuppressive drug regimens by 40 percent when healthcare providers tracked their adherence and offered tips for improvement. The participants used prescription bottles with wireless tracking that recorded when they opened their medicine bottle -- an indication that a dose was taken.

The six-month study used a randomized controlled trial design of 30 adult renal transplant recipients, which was broken down into two groups. While the results were positive, investigators concluded that "a fully-powered study with a diverse sample is needed to confirm these preliminary findings." More here.

In November 2009 a somewhat similar study was published in the journal Pediatrics: Investigators tested the efficacy of text message reminders on adherence to medication regimens among young liver transplant patients at Mt. Sinai. The study concluded that the messages did in fact increase adherence to regimens, but more importantly it led to better outcomes: While 12 of the 41 patients had experienced rejection episodes during the year before starting the program, only two patients had such an episode during the program. Patients could customize their message volume in the study. For example, they could choose to have multiple reminders leading up to a dose. An hour after taking their medication, teenagers had to text back that they had taken them, if they didn’t, their care giver or parent would get an alert to get on their case. More here.

This past June, The Boston-based Center for Connected Health, a division of Partners Healthcare, announced results from their own study of wireless electronic pill bottles and their effect on medication adherence for 139 patients taking blood pressure medication. The study found a 27 percent higher rate of medication adherence in patients using wireless-enabled medication packaging and feedback services compared to controls. Patients in the study were found to be 98 percent adherent. More here.

Of course, the study where SMS reminders for medication adherence failed received the most headlines: This past August the Wall Street Journal covered the story about results from a study published in Obstetrics & Gynecology. Investigators concluded that daily text message reminders did not help the 82 women in the study become more adherent to their birth control pill regimen. Both the text-receiving participants and the control group missed about 5 pills per month. More here.

Each of these studies, of course, leveraged different technologies and various support mechanisms. They also had relatively small sample sizes when compared to the efficacy study we highlighted last week (100,000 patients with connected implantable devices). The results, however, are largely positive. Last year the New England Health Institute estimated that not taking medications as prescribed leads to poorer health, more frequent hospitalization, a higher risk of death and as much as $290 billion annually in increased medical costs in the United States.

Are the investigators of the most recent study correct in stating that we need more "fully-powered" studies to confirm results?

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