Date Presented 03/28/20
This presentation will describe a novel assistive technology intervention: customized pillboxes. We will also describe the results of a small, randomized controlled trial that compares medication adherence and device satisfaction across the three study arms: (1) standard pillboxes, (2) individualized store-bought pillboxes, and (3) 3-D printed pillboxes.
Primary Author and Speaker: Jaclyn Schwartz
Additional Authors and Speakers: Yaritza Caceres, Ana Centeno, Vanessa Cruz, Jessyka Gutierrez, Nicte Orozco
PURPOSE: Many individuals do not take medicine as prescribed resulting in declines in health and function (Brown et al., 2016). Some evidence suggests that pillboxes are a cost effective and easy-to-implement intervention that can help people better take their medications as prescribed (Bartlett Ellis, Knisely, Boyer, & Pike, 2017). Other evidence suggests that pillboxes have no effect on medication adherence (Choudhry et al., 2017). Unfortunately, much of the pillbox literature lacks the methodological rigor of a strong assistive technology study (Schwartz, Foster, & Smith, 2017). We hypothesized that the level of pillbox customization was one of the factors driving the effectiveness of pillbox interventions. This consideration had not been evaluated in previous studies. The purpose of this study was twofold: 1) test the feasibility of a pillbox study methodology that considers pillbox level of customization and 2) to understand the impact of pillbox customization on device satisfaction and medication adherence.
DESIGN: A convenience sample of pillbox-using medication consumers recruited from the community participated in an experimental randomized controlled study.
METHOD: Participants completed three instruments: 1) a demographics questionnaire, 2) the Adherence to Refills and Medication Scale (ARMS) to measure medication adherence, and 3) the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 (QUEST 2.0) to measure device satisfaction. All participants received a new pillbox in addition to training on how to use the pillbox. Participants were randomized to receive 1 of 3 pillboxes: 1) a standard one-dose per 7-day pillbox, 2) a individualized store-bought pillbox that was purchased to accommodate the participant’s interests and abilities, and 3) a 3D printed pillbox designed and manufactured to accommodate the participant’s interests and abilities. The participants had 4 interactions with the team: 1) on-line screening, 2) informed consent and baseline data collection, 3) pillbox administration and training, and 4) follow-up data collection. Data was analyzed using descriptive statistics and Cohen’s d to investigate effect size.
RESULTS: Fifteen participants (5 per group) successfully completed the study. Across pillboxes, participants improved their device satisfaction from before to after. The effect sizes for the changes were large (d=1.72) for the standard pillbox, moderate (d=0.55) for the store-bought pillbox, and large (d=1.01) for the 3D printed pillbox. Medication adherence improved for the store-bought and 3D printed pillboxes with small (d=0.30) and large (d=0.87) effect sizes respectively. For the standard pillbox, medication adherence declined with a small (d=-0.36) effect size.
CONCLUSION: This study demonstrates that it is feasible to conduct a pillbox study that accounts for level of pillbox customization. Findings suggest that any novel pillbox improves device satisfaction, but that greater customization is associated with higher medication adherence. More research is warranted with larger sample sizes. The impact of this work is two-fold. First, it demonstrates that an assistive technology research methodology can advance the science of medication adherence. Second, it demonstrates the potential for unique interventions that can be offered by occupational therapy practitioners serving on the medication adherence team.
References
Bartlett Ellis, R. J., Knisely, M. R., Boyer, K., & Pike, C. (2017). Pillbox intervention fidelity in medication adherence research: A systematic review. Nursing Outlook, 65(4), 464–476. https://doi.org/10.1016/J.OUTLOOK.2016.12.011
Brown, M. T., Bussell, J., Dutta, S., Davis, K., Strong, S., & Mathew, S. (2016). Medication Adherence: Truth and Consequences. American Journal of the Medical Sciences, 351(4), 387–399. https://doi.org/10.1016/j.amjms.2016.01.010
Choudhry, N. K., Krumme, A. A., Ercole, P. M., Girdish, C., Tong, A. Y., Khan, N. F., … Franklin, J. M. (2017). Effect of Reminder Devices on Medication Adherence. JAMA Internal Medicine, 314(17), 1818–1831. https://doi.org/10.1001/jamainternmed.2016.9627
Schwartz, J. K., Foster, A., & Smith, R. O. (2017). Effects of reminder devices on medication adherence - An assistive technology perspective. JAMA Internal Medicine, 177(10). https://doi.org/10.1001/jamainternmed.2017.3996
