A randomized trial comparing in person and electronic interventions for improving adherence to oral medications in schizophrenia

Abstract

Poor adherence to medication leads to symptom exacerbation and interferes with the recovery process for patients with schizophrenia. Following baseline assessment, 142 patients in medication maintenance at a community mental health center were randomized to one of 3 treatments for 9 months: (1) PharmCAT, supports including pill containers, signs, alarms, checklists and the organization of belongings established in weekly home visits from a PharmCAT therapist; (2) Med-eMonitor (MM), an electronic medication monitor that prompts use of medication, cues the taking of medication, warns patients when they are taking the wrong medication or taking it at the wrong time, record complaints, and, through modem hookup, alerts treatment staff of failures to take medication as prescribed; (3) Treatment as Usual (TAU). All patients received the Med-eMonitor device to record medication adherence. The device was programmed for intervention only in the MM group. Data on symptoms, global functioning, and contact with emergency services and police were obtained every 3 months. Repeated measures analyses of variance for mixed models indicated that adherence to medication was significantly better in both active conditions than in TAU (both p<0.0001). Adherence in active treatments ranged from 90-92% compared to 73% in TAU based on electronic monitoring. In-person and electronic interventions significantly improved adherence to medication, but that did not translate to improved clinical outcomes. Implications for treatment and health care costs are discussed.

Keywords: cognitive adaptation; electronic adherence intervention; environmental supports; medication adherence; medication compliance; pill containers; smart; training.

Fig. 1.

Consort diagram.

Fig. 2.

Adherence over time by group as measured by electronic monitoring. Main effect of group F(2,265) = 47.29; P < .0001; Main effect of visit F(2,365) = 0.06 P > .94; Group by visit F(4,365) = 0.44; P > .77. P values for PharmCAT and Med-eMonitor vs standard treatment were <.0001 at all time points. P values for PharmCAT vs MM were >.43 at all time points.

Fig. 3.

Proportion of patients who had contact with emergency services as obtained by weekly queries from a smart pill container. There were no differences in numbers of patients using psychiatric emergency services by treatment group (2× value = 0.5327, P value = .7662).