Review of electronic adherence monitoring devices in chronic disease – effect on adherence and outcomes

Abstract

Background: Poor medication adherence is associated with increased morbidity and mortality. Electronic adherence monitoring devices (EMDs) have emerged, some of which incorporate adherence-promoting functions such as reminders, but the effectiveness of these devices in improving adherence and clinical outcomes is not yet known. Methods: A systematic literature search of databases including Ovid, MEDLINE, EMBASE, PsycINFO, and CINAHL was conducted for all randomised controlled trials published between 1946 and March 2015 which assessed the effect of EMDs in chronic disease. Outcomes of interest included adherence, clinical outcomes and patient feedback on the EMD or adherence intervention. Findings: Thirty-six trials were included investigating 4437 total patients. Most (81% - 29/36) were in adults, in an outpatient setting (47% - 17/36), and focused on tablet dose forms (56% - 20/36). Significant improvements in adherence were reported in two-thirds (67% - 24/36) of studies, though 3 noted this was lost when the EMD-based adherence intervention was removed. Clinical outcomes were measured in 78% (28/36) of studies; only 29% (8/28) of these showed statistically significant improvements. These trials were in children with asthma, adults with HIV and older adults with cardiac conditions. Patient-perceived EMD acceptability was reported in 17% (6/36) of studies; feedback was negative in two-thirds (4/6) of these and included complaints about device size and intrusiveness. Discussion: EMDs have the potential to improve adherence but whether these improvements translate into clinical benefits is unclear. Further research measuring effects on clinical outcomes and patient acceptability of EMDs is needed.