Interventions to Improve Medication Adherence

A lot, a real lot, of capital has gone into wireless bill bottles that are supposed to facilitate better medication adherence, which in turn is supposed to improve meaningful health outcomes.  According to a study in the Journal of American Medical Association Internal Medicine, that may not occur.   (JAMA Int. Med. Art.)   The researchers conducted a randomized clinical trial with 1509 patients who had a recent hospitalization for a heart attack.  The intervention group got wireless pill bottles, which send messages when they are opened and theoretically can be used to track whether a patient is taking their drugs (or at least opening their pill bottles!) and then follow-up with interventions if they appear not to be adhering to their medication adherence.  In addition, there were financial incentives for adherence and social support to encourage it.  The control group got usual care, whatever that is.  The primary outcome was the time to the first rehospitalization for the vascular condition or to death of the patient.  Secondary outcomes included time to first all-cause rehospitalization, the number of repeat hospitalizations, medication adherence measures and total medical costs.  The intervention lasted for 12 months.

There was no statistical difference in any of the outcomes.  Medication adherence was almost identical between the intervention and control groups.  Medical costs did appear to be lower in the intervention group, but not at a statistically significant level.  Wireless pill bottles sound great, like a lot of things do, but they add to spending, they create yet more information that someone has to track and they apparently don’t make a real difference, at least according to this study.  Once again, we can see the enormous value of well-done credible research in helping to steer the health system in the right direction in finding meaningful solutions to spending and quality issues.