Adherence to hydroxyurea medication by children with sickle cell disease (SCD) using an electronic device: a feasibility study

Abstract

Adherence to hydroxyurea (HU) is a significant modifying factor in sickle cell vaso-occlusive pain. We conducted a study using an electronic medication container-monitor-reminder device (GlowCap™) to track adherence and determine whether use of this device affected rates of HU adherence. Subjects were regular attendees to our clinic. They were given a 37-item questionnaire and were asked to use a GlowCap containing HU. When the device cap is opened, it makes a remote "medication taken" record. The device also provides usage reminder in the form of lights and alarm sounds if the cap opening is delayed. Nineteen subjects participated in the survey, and 17 in the intervention phase. Of the 17, 12 had reliable adherence data. Seventeen caregivers of patients and two patients completed the survey. Two most common barriers to adherence identified were lack of reminders and absence of medicine home delivery. The intervention component of this study, which used both the electronic (GlowCap) method and medication possession ratio showed that the median adherence rate for the 12 patients evaluated was 85 %. The GlowCap device accurately kept a record of adherence rates. This device may be an effective tool for increasing HU medication adherence.

Patient-Centered eHealth Interventions for Children, Adolescents, and Adults With Sickle Cell Disease: Systematic Review

“…Multimedia Appendix 3 [ 52 - 67 ] summarizes the studies’ characteristics. The aims of the interventions were (1) monitoring or improvement, or both, of medication adherence, including hydroxyurea [ 53 , 54 , 58 , 63 ], iron chelation [ 61 ], or asthma medications [ 63 ]; (2) self-management [ 52 , 59 , 60 , 62 , 64 , 66 ]; (3) pain and symptom reporting [ 52 , 55 , 59 , 60 , 62 , 64 ]; (4) stress, coping, sleep, and daily activities reporting [ 55 , 59 , 62 , 64 ]; (5) cognitive training for memory [ 57 ]; (6) disease education to improve SCD and [ 56 , 61 , 65 - 67 ] reproductive health knowledge [ 56 , 65 ]; and (7) cognitive behavioral therapy [ 62 , 64 ] and guided relaxation interventions [ 55 ]. All studies were performed in the United States [ 52 - 67 ].…”

“…All studies were performed in the United States [ 52 - 67 ]. Enrollment was mainly from clinics [ 52 - 58 , 60 - 66 ], as well as inpatients [ 67 ], the public [ 65 ], online networks [ 65 ], home [ 56 , 65 ], or community-based organizations [ 56 , 59 , 65 ]. All studies were conducted in the outpatient setting [ 52 - 66 ], except for 1 study conducted in the inpatient setting [ 67 ].…”

“…All studies were conducted in the outpatient setting [ 52 - 66 ], except for 1 study conducted in the inpatient setting [ 67 ]. Most studies included older children or adolescents (mean or median age 10-17 years) [ 52 - 54 , 57 - 59 , 61 , 62 , 64 , 66 , 67 ], 5 studies included young adults (≥18 years old) [ 55 , 56 , 60 , 63 , 65 ], and 2 studies allowed parents to participate [ 54 , 58 ]. None of the included studies involved potential users, patients, or parents in the development of the intervention before it was tested.…”

“…Sample size ranged from 11 to 236, with a median of 21 per study; 6 enrolled fewer than 20 participants [ 53 , 57 , 58 , 60 - 62 ], 6 had 20 to 50 participants [ 52 , 55 , 56 , 63 , 64 , 66 ], and 4 enrolled more than 50 participants [ 54 , 59 , 65 , 67 ].…”

Disparities in hypertension and cardiovascular disease in blacks: The critical role of medication adherence

“…For instance, a wireless electronic pill bottle, which reminded patients with hypertension to take their medication by emitting light and sound, increased medication adherence by 27%, over the control group. 37 There are no data on racial disparities.…”