title: A technology-enabled adherence enhancement system for people with bipolar disorder: results from a feasibility and patient acceptance analysis.
abstract: OBJECTIVE
  As poor medication adherence is common in bipolar disorder (BD), technology-assisted approaches may help to monitor and enhance adherence. This study evaluated preliminary feasibility, patient satisfaction and effects on adherence, BD knowledge, and BD symptoms associated with the use of a multicomponent technology-assisted adherence enhancement system.
  
  
  METHODS
  This prospective study tested the system in five BD patients over a 15-day period. System components included: 1) an automated pill cap with remote monitoring sensor; 2) a multimedia adherence enhancement program; and 3) a treatment incentive program. This study evaluated system usability, patient satisfaction and effects on adherence (Morisky scale), knowledge (treatment knowledge test [TKT]), and symptoms (internal state scale [ISS]).
  
  
  RESULTS
  Mean age of the sample was 62 years, 4/5 (80%) Caucasian, and 4/5 (80%) single/divorced or widowed. Most participants (4/5, 80%) were on a single BD medication. Participants had BD for an average of 21 years. Challenges included attaching the pill sensor to standard pharmacy bottles for individuals using very large pill containers or those with multiday pill boxes. Three of five (60%) individuals completed the full 15-day period. Usability scores were high overall. Mean Morisky scores improved. Means on all four subscales of the ISS were all in the direction of improvement. On the TKT, there was a 40% increase in mean scores.
  
  
  CONCLUSIONS
  A multicomponent technology-assisted BD adherence enhancement system is feasible. Challenges include accommodating multiple types of pill containers and monitoring multiple drugs simultaneously. The system can also generate adherence information that is potentially useful for treatment planning.
authors.affiliation: Department of Psychiatry and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
authors.affiliation: MedicaSafe, New York, NY, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Davis
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Cassidy
authors.affiliation: MedicaSafe, New York, NY, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Nestor
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Johnny
authors.initials: J
authors.lastname: Sams
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Edna
authors.initials: E
authors.lastname: Fuentes-Casiano
keywords: adherence; bipolar disorder; compliance; manic depressive disorder; mood stabilizers