Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Mar 12;6(3):e12493.
doi: 10.2196/12493.

Technological Interventions for Medication Adherence in Adult Mental Health and Substance Use Disorders: A Systematic Review

Jackson M Steinkamp  1 , Nathaniel Goldblatt  2 , Jacob T Borodovsky  3 , Amy LaVertu  4 , Ian M Kronish  5 , Lisa A Marsch  6 , Zev Schuman-Olivier  2   6   7
Affiliations

Technological Interventions for Medication Adherence in Adult Mental Health and Substance Use Disorders: A Systematic Review

Jackson M Steinkamp et al. JMIR Ment Health. .

Abstract

Background: Medication adherence is critical to the effectiveness of psychopharmacologic therapy. Psychiatric disorders present special adherence considerations, notably an altered capacity for decision making and the increased street value of controlled substances. A wide range of interventions designed to improve adherence in mental health and substance use disorders have been studied; recently, many have incorporated information technology (eg, mobile phone apps, electronic pill dispensers, and telehealth). Many intervention components have been studied across different disorders. Furthermore, many interventions incorporate multiple components, making it difficult to evaluate the effect of individual components in isolation.

Objective: The aim of this study was to conduct a systematic scoping review to develop a literature-driven, transdiagnostic taxonomic framework of technology-based medication adherence intervention and measurement components used in mental health and substance use disorders.

Methods: This review was conducted based on a published protocol (PROSPERO: CRD42018067902) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. We searched 7 electronic databases: MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science, Engineering Village, and ClinicalTrials.gov from January 2000 to September 2018. Overall, 2 reviewers independently conducted title and abstract screens, full-text screens, and data extraction. We included all studies that evaluate populations or individuals with a mental health or substance use disorder and contain at least 1 technology-delivered component (eg, website, mobile phone app, biosensor, or algorithm) designed to improve medication adherence or the measurement thereof. Given the wide variety of studied interventions, populations, and outcomes, we did not conduct a risk of bias assessment or quantitative meta-analysis. We developed a taxonomic framework for intervention classification and applied it to multicomponent interventions across mental health disorders.

Results: The initial search identified 21,749 results; after screening, 127 included studies remained (Cohen kappa: 0.8, 95% CI 0.72-0.87). Major intervention component categories include reminders, support messages, social support engagement, care team contact capabilities, data feedback, psychoeducation, adherence-based psychotherapy, remote care delivery, secure medication storage, and contingency management. Adherence measurement components include self-reports, remote direct visualization, fully automated computer vision algorithms, biosensors, smart pill bottles, ingestible sensors, pill counts, and utilization measures. Intervention modalities include short messaging service, mobile phone apps, websites, and interactive voice response. We provide graphical representations of intervention component categories and an element-wise breakdown of multicomponent interventions.

Conclusions: Many technology-based medication adherence and monitoring interventions have been studied across psychiatric disease contexts. Interventions that are useful in one psychiatric disorder may be useful in other disorders, and further research is necessary to elucidate the specific effects of individual intervention components. Our framework is directly developed from the substance use disorder and mental health treatment literature and allows for transdiagnostic comparisons and an organized conceptual mapping of interventions.

Keywords: mHealth; medication adherence; medication compliance; mental health; psychiatry; substance-related disorders; systematic review.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: JMS, JTB, ZS-O, and LAM are affiliated with MySafeRx, a nonprofit organization that supports the development, implementation, and dissemination of technological solutions for medication adherence in mental health and substance use disorder treatment. From 2017 to 2018, JMS received a salary as a software developer for MySafeRx. No other conflicts of interest are declared.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses Diagram of included studies.
Figure 2
Figure 2
Included articles by year.
Figure 3
Figure 3
Included articles by year, divided by total number of MEDLINE articles published during that same year.
Figure 4
Figure 4
Number of articles by diagnosis. ADHD: attention deficit hyperactivity disorder.
Figure 5
Figure 5
Visual concept map of components of studied technological systems. GPS: global positioning system.
See this image and copyright information in PMC

References

    1. Witt K, van Dorn R, Fazel S. Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies. PLoS One. 2013;8(2):e55942. doi: 10.1371/journal.pone.0055942. http://dx.plos.org/10.1371/journal.pone.0055942 PONE-D-12-25677 - DOI - DOI - PMC - PubMed
    1. Higashi K, Medic G, Littlewood KJ, Diez T, Granström O, de Hert M. Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review. Ther Adv Psychopharmacol. 2013 Aug;3(4):200–18. doi: 10.1177/2045125312474019. http://europepmc.org/abstract/MED/24167693 10.1177_2045125312474019 - DOI - PMC - PubMed
    1. Cullen BA, McGinty EE, Zhang Y, Dosreis SC, Steinwachs DM, Guallar E, Daumit GL. Guideline-concordant antipsychotic use and mortality in schizophrenia. Schizophr Bull. 2013 Sep;39(5):1159–68. doi: 10.1093/schbul/sbs097. http://europepmc.org/abstract/MED/23112292 sbs097 - DOI - PMC - PubMed
    1. Gonzalez-Pinto A, Mosquera F, Alonso M, López P, Ramírez F, Vieta E, Baldessarini RJ. Suicidal risk in bipolar I disorder patients and adherence to long-term lithium treatment. Bipolar Disord. 2006 Oct;8(5 Pt 2):618–24. doi: 10.1111/j.1399-5618.2006.00368.x.BDI368 - DOI - PubMed
    1. Meyers BS, Sirey JA, Bruce M, Hamilton M, Raue P, Friedman SJ, Rickey C, Kakuma T, Carroll MK, Kiosses D, Alexopoulos G. Predictors of early recovery from major depression among persons admitted to community-based clinics: an observational study. Arch Gen Psychiatry. 2002 Aug;59(8):729–35.yoa20162 - PubMed

LinkOut - more resources