A study of medication-taking and unobtrusive, intelligent reminding.

Poor medication adherence is one of the major causes of illness and of treatment failure in the United States. The objective of this study was to conduct an initial evaluation of a context-aware reminder system, which generated reminders at an opportune time to take the medication. Ten participants aged 65 or older, living alone and managing their own medications, participated in the study. Participants took a low-dose vitamin C tablet twice daily at times that they specified. Participants were considered adherent if they took the vitamin within 90 minutes (before or after) of the prescribed time. Adherence and activity in the home was measured using a system of sensors, including an instrumented pillbox. There were three phases of the study: baseline, in which there was no prompting; time-based, in which there was prompting at the prescribed times for pill-taking; and context-aware, in which participants were only prompted if they forgot to take their pills and were likely able to take their pills. The context-based prompting resulted in significantly better adherence (92.3%) as compared to time-based (73.5%) or no prompting (68.1%) conditions (p < 0.0002, chi(2) = 17.0). In addition, subjects had better adherence in the morning than in the evening. We have shown in this study that a system that generates reminders at an opportune time to take the medication significantly improves adherence. This study indicates that context-aware prompting may provide improved adherence over standard time-based reminders.

[1]  Janna C. Kimel,et al.  Continuous Activity Monitoring and Intelligent Contextual Prompting to Improve Medication Adherence , 2007, 2007 29th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[2]  Misha Pavel,et al.  A Statistical Reasoning System for Medication Prompting , 2007, UbiComp.

[3]  R Brian Haynes,et al.  Interventions to enhance medication adherence in chronic medical conditions: a systematic review. , 2007, Archives of internal medicine.

[4]  Christopher B. Mayhorn,et al.  Persuasive Pillboxes: Improving Medication Adherence with Personal Digital Assistants , 2006, PERSUASIVE.

[5]  D. Schreiber,et al.  Drug-Related Emergency Department Visits in an Elderly Veteran Population , 2005, The Annals of pharmacotherapy.

[6]  L. Osterberg,et al.  Adherence to medication. , 2005, The New England journal of medicine.

[7]  David P Graham,et al.  The Alzheimer's Disease Assessment Scale - Cognitive Subscale: Normative Data for Older Adult Controls , 2004, Alzheimer disease and associated disorders.

[8]  Adrian R Levy,et al.  Self-Reported Morisky Score for Identifying Nonadherence with Cardiovascular Medications , 2004, The Annals of pharmacotherapy.

[9]  Rajesh Balkrishnan,et al.  Adherence to topical therapy decreases during the course of an 8-week psoriasis clinical trial: commonly used methods of measuring adherence to topical therapy overestimate actual use. , 2004, Journal of the American Academy of Dermatology.

[10]  Dieter Fox,et al.  Bayesian Filtering for Location Estimation , 2003, IEEE Pervasive Comput..

[11]  H. Mcdonald,et al.  Interventions to enhance patient adherence to medication prescriptions: scientific review. , 2002, JAMA.

[12]  K A McKibbon,et al.  Interventions for helping patients to follow prescriptions for medications. , 2002, The Cochrane database of systematic reviews.

[13]  D. Drane,et al.  Demographic characteristics and normative observations for derived-trail making test indices. , 2002, Neuropsychiatry, neuropsychology, and behavioral neurology.

[14]  N. Ampel,et al.  Barriers to Use of Electronic Adherence Monitoring in an HIV Clinic , 2001, The Annals of pharmacotherapy.

[15]  J J Branin,et al.  The Role of Memory Strategies in Medication Adherence Among the Elderly , 2001, Home health care services quarterly.

[16]  R. Goldberg,et al.  Discrepancies in the use of medications: their extent and predictors in an outpatient practice. , 2000, Archives of internal medicine.

[17]  K. Namkoong,et al.  Measurement of compliance with naltrexone in the treatment of alcohol dependence: research and clinical implications. , 1999, The Journal of clinical psychiatry.

[18]  A. Szeto,et al.  Improving oral medication compliance with an electronic aid. , 1997, IEEE engineering in medicine and biology magazine : the quarterly magazine of the Engineering in Medicine & Biology Society.

[19]  K. A. McKibbon,et al.  Systematic review of randomised trials of interventions to assist patients to follow prescriptions for medications , 1996, The Lancet.

[20]  M P Lawton,et al.  Validation of the Cumulative Illness Rating Scale in a Geriatric Residential Population , 1995, Journal of the American Geriatrics Society.

[21]  J. Whatling.  Childhood asthma and passive smoking. , 1994, Nursing standard (Royal College of Nursing (Great Britain) : 1987).

[22]  Whyte La.  Medication cards for elderly people: a study. , 1994 .

[23]  G. Shenfield,et al.  Functional ability of patients to manage medication packaging: a survey of geriatric inpatients. , 1994, Age and ageing.

[24]  J. Morris.  The Clinical Dementia Rating (CDR) , 1993, Neurology.

[25]  J. Breitner,et al.  Detection of dementia in the elderly using telephone screening of cognitive status , 1993 .

[26]  R. Botelho,et al.  Home assessment of adherence to long-term medication in the elderly. , 1992, The Journal of family practice.

[27]  R. Zec,et al.  Alzheimer Disease Assessment Scale: A Subtest Analysis , 1992, Alzheimer disease and associated disorders.

[28]  G Koren,et al.  Compliance assessed by the Medication Event Monitoring System. , 1991, Archives of disease in childhood.

[29]  N. Col,et al.  The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. , 1990, Archives of internal medicine.

[30]  J. Cramer,et al.  How often is medication taken as prescribed? A novel assessment technique. , 1989, JAMA.

[31]  D. Morrow,et al.  Elders' Nonadherence, Its Assessment, and Computer Assisted Instruction for Medication Recall Training , 1988, Journal of the American Geriatrics Society.

[32]  Mark E. Williams,et al.  Quantifying the Ease or Difficulty Older Persons Experience in Opening Medication Containers , 1988, Journal of the American Geriatrics Society.

[33]  R. Wallace,et al.  Medication Use Characteristics in the Elderly: The Iowa 65+ Rural Health Study , 1987, Journal of the American Geriatrics Society.

[34]  J. Yesavage,et al.  Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. , 1986 .

[35]  D. Christensen,et al.  Medication Usage in an Elderly Population , 1985, Medical care.

[36]  J. Bayne,et al.  Compliance with prescribed medication by elderly patients. , 1982, Canadian Medical Association journal.

[37]  Martin Crowder,et al.  Beta-binomial Anova for Proportions , 1978 .

[38]  S. Folstein,et al.  “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician , 1975 .

[39]  L. Kennedy.  Effect of Medication Nonadherence on Hospitalization and Mortality Among Patients With Diabetes Mellitus , 2007 .

[40]  Andre Gustavo Adami,et al.  An Electronic Pillbox for Continuous Monitoring of Medication Adherence , 2006, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.

[41]  K. Chien,et al.  BMC Cardiovascular Disorders BioMed Central , 2006 .

[42]  Min Wang,et al.  A Flexible, Low-Overhead Ubiquitous System for Medication Monitoring , 2003 .

[43]  L. Burke,et al.  Clinical assessment and management of adherence to medical regimens. , 1995 .

[44]  R. Zec,et al.  Alzheimer Disease Assessment Scale: Useful for Both Early Detection and Staging of Dementia of the Alzheimer Type , 1992, Alzheimer disease and associated disorders.

[45]  M. Becker.  Theoretical models of adherence and strategies for improving adherence. , 1990 .

[46]  Wesley G. Skogan,et al.  Issues in the measurement of victimization , 1981 .