An electronic pillbox intervention designed to improve medication safety during care transitions: challenges and lessons learned regarding implementation and evaluation

Abstract

Background Adverse drug events are common during transitions of care. As part of the Smart Pillbox study, a cluster-randomized controlled trial of an electronic pillbox designed to reduce medication discrepancies and improve medication adherence after hospital discharge, we explored barriers to successful implementation and evaluation of this intervention. Methods Eligible patients were those admitted to a medicine service of a large teaching hospital with a plan to be discharged home on five or more chronic medications. The intervention consisted of an electronic pillbox with pre-filled weekly blister pack medication trays given to patients prior to discharge. Pillbox features included alarms to take medications, detection of pill removal from each well, alerts to patients or caregivers by phone, email, or text if medications were not taken, and adherence reports accessible by providers. Greater than 20% missed doses for three days in a row triggered outreach from a pharmacist. To identify barriers to implementation and evaluation of the intervention, we reviewed patient exit surveys, including quantitative data on satisfaction and free-text responses regarding their experiences; technical issue logs; and team meeting minutes. Themes were derived by consensus among the study authors and organized using the Consolidated Framework for Implementation Research. Results Barriers to implementation included intervention characteristics such as perceived portability issues with the pillbox and time required by pharmacists to enter medication information into the software; external policies such as lack of insurance coverage for early refills and regulatory prohibitions on repackaging medications; implementation climate issues such as the incompatibility between the rushed nature of hospital discharge with the time required to deploy the intervention; and patient issues such as denial of previous problems with medication adherence. We founds several obstacles to conducting the study, including patients declining study enrollment and limited attempts by the hospital to streamline logistics by building the intervention into usual care. Several solutions to address many of these challenges were implemented or planned. Despite these challenges, many patients with the pillbox were pleased with the service and believed the intervention worked well for them. Conclusions In this evaluation, several barriers to implementing and conducting a study of the effectiveness of the intervention were identified. Our findings provide lessons learned for others wishing to implement and evaluate HIT-related interventions designed to improve medication safety during care transitions. Trial registration Clinicaltrials.gov NCT03475030

Patient, Caregiver, and Clinician Experience with a Technologically Enabled Pillbox: A Qualitative Study

“…Primary outcomes of the trial reporting the impact of the smart pillbox on medication adherence and chronic disease control and a report on the challenges of deploying a complex HIT intervention will be published separately. 38…”

“…While we did not include pharmacists in this qualitative study, perspectives from this key group are shared in an accompanying manuscript. 38 Second, our study was performed at a single, well-resourced academic medical center in the Northeast United States as part of a randomized trial. Additionally, the majority of patients included were Whites and college educated with high medical literacy.…”

Adhesión terapéutica en neurología

“…Algunos de los abordajes pueden suponer simplificar los regímenes terapéuticos, enseñar y modificar las creencias de los pacientes, mejorar la comunicación con los pacientes y evaluar periódicamente la adhesión55 . Se ha propuesto el uso de calendarios y alarmas que permiten recordar a los pacientes cuándo tomar la medicación56 , cajas de medicación inteligentes que dispensan y cuentan las dosis57,58 , además de acciones obvias como llamar por teléfono a los pacientes59 . Existen, por ejemplo, formulaciones de aripiprazol que contienen un sensor dentro del comprimido que envía una señal a un smartphone cuando el paciente lo ha ingerido60 .…”