​Low cost devices that remind patients to take their medicine do not improve adherence among those taking up to three medications, according to an original investigation in the May 2017 issue of JAMA-Internal Medicine. The researchers conducted a block-randomized, four-arm clinical trial of 53,480 patients in a major pharmacy's database to see whether three low-cost devices would improve adherence. The devices were a pill bottle with an affixed strip that can be toggled each day after a dose is taken; a pill bottle cap with a digital timer that shows how much time has elapsed since medication was last taken; and a standard plastic pillbox with a compartment for each day of the week. No significant increase in optimal adherence was seen in any intervention group when compared with a control group over 12 months of follow-up. Patients who received the pillbox with daily compartments were more likely to achieve optimal adherence than the patients who were assigned one of the other two interventions. To target patients who were most likely to benefit, the study enrolled only participants who showed suboptimal adherence to all of their qualifying medicines during the year before the study. The study was restricted to patients who filled between one and three oral medications to limit the number of devices used. Future research should focus on finding effective strategies that can ensure sustained use of these interventions, the authors concluded.

HRC Recommends: Healthcare providers and organizations can take steps to promote patient adherence to medication regimens. Health literacy and patient-engagement strategies, such as Ask Me 3 and teach back, can support adherence. Providers should seek to establish an open, trusting relationship with patients and ask patients about their care goals, their thoughts about proposed tests and treatments, and barriers to and facilitators of medication adherence. Communication-skills training can support providers in these efforts. Strategies to facilitate medication adherence include working with patients to prescribe medications, creating schedules in ways that meet the patient's needs, supplying medications in blister packs of medications to be taken at the same time of day, and using reminder technologies.