16 July 2024 : Review article
Innovative Approaches to Enhance and Measure Medication Adherence in Chronic Disease Management: A Review
Michał Gackowski
1ABEF*, Magdalena Jasińska-Stroschein 2AE, Tomasz Osmałek 1AE, Magdalena Waszyk-Nowaczyk 3AEG
DOI: 10.12659/MSM.944605
Med Sci Monit 2024; 30:e944605
Introduction
Overview of Medication Adherence Measurements Models
Healthcare Assessment
Self-Reporting
Drug Level Measures
Pill Count
Electronic Medication Packaging (EMP) Devices
Directly Observed Therapy (DOT)
Secondary Database Measurements
Mobile Applications and Artificial Intelligence
Video Observed Therapy (VOT)
Mobile Health Applications (MHealth Apps)
Questionnaires and Scales
New Developments in Adherence Monitoring Packages (EMPs)
Medication Event Monitoring System (MEMS)
Wisepill Device
SMARxT Cap
One-Dose Package Medication Support System (ODP-MSS)
ReX
Smart Blister Packs
SmartMed
Time4Med
Smart Pens
Smart Inhaler
Ingestible Biosensors (IS)
Future Initiatives
Conclusions
References
Table 1 Summary of identified methods for measuring medication adherence.
| No. | Category of medication adherence measurement model | Description of method | Advantages | Disadvantages | Ref. |
|---|---|---|---|---|---|
| 1. | Healthcare assessment | Healthcare providers evaluate patients’ medication behavior and knowledge of prescribed regimens through interviews; this is a subjective and indirect method. | [,]1 | ||
| 2. | Self-reporting, eg: | The patient (or the patient’s relatives) answers the questions (dichotomous multiple choice or scale-based) in the questionnaire given to them; based on the answers, the patient’s level of adherence and reasons for low adherence and barriers to adherence are assessed; this is a subjective and indirect method | [,–, ]5 | ||
| 3. | Drug level measures | Determination of drug levels in blood, urine, or saliva samples provides insight into whether a patient took the drug or not; this is an objective and direct method | [,, ,]28 | ||
| 4. | Electronic monitoring devices, eg: | An electronic device is programmed to record every dosing event; the data is then stored and can be analyzed in detail by healthcare providers; this is an objective and indirect method | [,]72 | ||
| 5. | Secondary database measurements | Assessing and quantifying how well patients adhere to their prescribed medication regimens using data from secondary sources (from primary sources such as electronic prescription services, pharmacy claims, or other health records); this is an objective and indirect method | [,]1 | ||
| 6. | Pill count | Patients are given a certain number of pills in a prepared container and then are asked to bring this container to their next visit; the healthcare provider calculates how many pills the patient should have left in the container; on this basis, the level of adherence is calculated; this is an objective and indirect method | [,]33 | ||
| 7. | Directly observed therapy | Healthcare professional watches a person take each dose of medication; the WHO has introduced this strategy to ensure treatment adherence; this is an objective and direct method | No data | [,]42 | |
| 8. | Electronic diaries | Patients manually document their medication intake using mobile devices such as phones, tablets, and computers; these devices are tightly integrated with a website or application; the data are transmitted wirelessly; no changes can be made once participants have entered their data into the e-diary and confirmed its accuracy; this is a subjective and indirect method | [,]42 | ||
| 9. | Video observed therap, MHealth Apps: | Remote monitoring of medication adherence, using live or pre-recorded video technology for patients to show how they are taking their medication; a healthcare provider or artificial intelligence verifies the act of medication administration;this is an objective and indirect method | [,]45 | ||
| 10. | Ingestible biosensors, e.g.: | The system consists of a biosensor embedded in a tablet/capsule, a detector patch applied to the skin, and a mobile app that enables accurate date- and time-stamping of actual oral medication ingestion through an integrated sensor system; upon ingestion, the sensor separates, energizes and communicates with the detector patch, which records physiological metrics; the system is powered by sensors that use the electrolytes in the stomach; this is an objective and direct method | [–, ,]91 | ||
| WHO – World Health Organization; DOT – Directly Observed Therapy; VOT – Video Observed Therapy; A-VOT – Asynchronous Video Observed Therapy; S-VOT – Synchronous Video Observed Therapy. | |||||