Randomized controlled feasibility trial of two telemedicine medication reminder systems for older adults with heart failure

Abstract

We conducted a feasibility study of a telehealth intervention (an electronic pill box) and an m-health intervention (an app on a smartphone) for improving medication adherence in older adults with heart failure. A secondary aim was to compare patient acceptance of the devices. The participants were 60 adults with HF (65% male). Their average age was 69 years and 83% were Caucasian. Patients were randomized using a 2 × 2 design to one of four groups: pillbox silent, pillbox reminding, smartphone silent, smartphone reminding. We examined adherence to 4 medications over 28 days. The overall adherence rate was 78% (SD 35). People with the telehealth device adhered 80% of the time and people with the smartphone adhered 76% of the time. Those who received reminders adhered 79% of the time, and those with passive medication reminder devices adhered 78% of the time, i.e. reminding did not improve adherence. Patients preferred the m-health approach. Future interventions may need to address other contributors to poor adherence such as motivation.

Effectiveness of Mobile Phone-Based Interventions for Improving Health Outcomes in Patients with Chronic Heart Failure: A Systematic Review and Meta-Analysis

“…This review showed a relatively moderate overall RoB. Four studies were rated to have a low RoB [27,29,31,32]. Three out of the eight studies were rated to have a high RoB [26,28,33], and the other studies were rated to have an unclear RoB [30].…”

“…Three out of the eight studies were rated to have a high RoB [26,28,33], and the other studies were rated to have an unclear RoB [30]. Random sequence generation was reported in five studies [27,29,[31][32][33]. However, three studies did not report how the allocation sequence was generated [27,29,33].…”

“…As shown in Table 1, eight RCTs with a total of 2534 patients were included in this systematic review. Seven studies were conducted in the United States and Europe [26][27][28][29][30][31][32], as well as one in China [33]. Of the patients, 1331 were allocated to the intervention group and 1203 to the control group.…”

The impact of medication nonadherence on the relationship between mortality risk and depression in heart failure.

“…With respect to antidepressants, neither sertraline nor escitalopram were effective for depression in HF (Angermann et al, 2016; O’Connor et al, 2010). Perhaps interventions should address medication adherence directly, although a pilot clinical trial of medication reminding found no improvement in adherence from pillbox alarms or smartphone reminders (Goldstein et al, 2014). Medication adherence interventions for patients with HF need further refinement and evidence of effectiveness.…”

Emerging Role of Digital Technology and Remote Monitoring in the Care of Cardiac Patients

“…[89][90][91] Additional resources include electronic medication packaging and medication message reminders using computer-or smartphone-based software. 92,93 One of the most promising sensor technologies is Proteus Digital's medication adherence tool (Proteus Digital Health, Inc, Redwood City, CA, USA); it is a physiologic sensor placed on a pill, which, when activated by gastric acid, emits a signal to a skin patch electrode that sends vital sign information and documents ingestion of the said pill. Smartphones and tablets, with consumer-directed wellness apps (tracking activity, heart rates, and sleep) have recently gained popularity.…”