Technological Innovations in Medication Packaging to Improve Patient Adherence: A Systematic Review

Abstract

Importance: Nonadherence to medications affects over one in four patients in the US, reaching as high as 50% for many chronic drug regimens. One strategy to combat nonadherence may be improved use of electronic medication packaging (EMP) devices built into the containers through which pills, inhalers, or other products are dispensed. Objective: To investigate whether EMP devices are effective in reducing medication nonadherence, identify common features of successful EMP devices, and assess the potential for this tool to reduce adverse outcomes related to nonadherence. Evidence Acquisition: Peer-reviewed research testing the effectiveness of electronic medication packaging was identified using a systematic literature search. The results describing the impact of the interventions on adherence as well as other key findings were extracted, and each study was formally assessed for bias using the guidelines outlined in the Cochrane Handbook for Systematic Reviews of Interventions. Finally, the devices described in each study were evaluated qualitatively in order to determine common features of EMP devices that may affect adherence outcomes. Results: A total of 37 studies met review criteria: 10 patient-interface-only “simple” interventions and 29 studies of “complex” interventions (2 qualified for both categories) in which the EMP devices were linked to care delivery by a physician, pharmacist, or other caregiver. Few studies of simple EMP interventions (3/10, 30%) improved medication adherence. By contrast, complex EMP interventions demonstrated improved adherence in a majority of studies (20/29, 69%). My qualitative review identified 5 prominent characteristics of EMP interventions: recording dosing events and storing a record of adherence, audiovisual reminders to cue dosing, digital displays, real-time monitoring, and providing patients with adherence performance feedback. Recording dosing events, digital displays, and providing feedback were most frequently found in studies that led to improved medication adherence. Conclusion and Relevance: This systematic review found that EMP devices can significantly improve medication adherence, particularly those that are integrated into the care delivery system and that are designed to record dosing events to give the opportunity for feedback. Well designed EMP devices can help physicians and patients seeking strategies to promote medication adherence.