Technology-mediated interventions for enhancing medication adherence.
BACKGROUND
Despite effective therapies for many conditions, patients find it difficult to adhere to prescribed treatments. Technology-mediated interventions (TMIs) are increasingly being used with the hope of improving adherence.


OBJECTIVE
To assess the effects of TMI, intended to enhance patient adherence to prescribed medications, on both medication adherence and clinical outcomes.


METHODS
A secondary in-depth analysis was conducted of the subset of studies that utilized technology in at least one component of the intervention from an updated Cochrane review on all interventions for enhancing medication adherence. We included studies that clearly described an information and communication technology or medical device as the sole or major component of the adherence intervention.


RESULTS
Thirty-eight studies were eligible for in-depth review. Only seven had a low risk of bias for study design features, primary adherence, and clinical outcomes. Eighteen studies used a TMI for education and/or counseling, 11 studies used a TMI for self-monitoring and/or feedback, and nine studies used electronic reminders. Studies used a variety of TMIs, with telephone the most common technology in use. Studies targeted a wide distribution of diseases and used a variety of adherence and clinical outcome measures. A minority targeted children and adolescents. Fourteen studies reported significant effects in both adherence and clinical outcome measures.


CONCLUSIONS
This review provides evidence for the inconsistent effectiveness of TMI for medication adherence and clinical outcomes. These results must be interpreted with caution due to a lack of high-quality studies.
Pediatric Outcomes Research Team (PORT), Division of Paediatric Medicine, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada Department of Pediatrics, St. Michael's Hospital, University of Toronto, Toronto, Canada niraj.mistry@mail.utoronto.ca.
Niraj
N
Mistry
Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton Canada Department of Medicine, McMaster University, Hamilton, Canada.
Arun
A
Keepanasseril
Health Information Research Unit, McMaster University, Hamilton, Canada.
Nancy L
NL
Wilczynski
Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton Canada.
Robby
R
Nieuwlaat
Health Information Research Unit, McMaster University, Hamilton, Canada.
Manthan
M
Ravall
Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton Canada Department of Medicine, McMaster University, Hamilton, Canada.
R Brian
RB
Haynes
D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D006801:Humans; D020407:Internet; D055118:Medication Adherence; D017010:Reminder Systems; D012646:Self Administration; D017216:Telemedicine; D013689:Telephone
eHealth; outcomes; patient adherence; reminder systems; systematic review; technology mediation