Patient and Partner Feedback Reports to Improve Statin Medication Adherence: A Randomized Control Trial.
BACKGROUND
Simple nudges such as reminders and feedback reports to either a patient or a partner may facilitate improved medication adherence.


OBJECTIVE
To test the impact of a pill bottle used to monitor adherence, deliver a daily alarm, and generate weekly medication adherence feedback reports on statin adherence.


METHODS
Three-month, three-arm randomized clinical trial (ClinicalTrials.gov identifier: NCT02480530).


METHODS
One hundred and twenty-six veterans with known coronary artery disease and poor adherence (medication possession ratio <80 %).


METHODS
Patients were randomized to one of three groups: (1) a control group (n = 36) that received a pill-monitoring device with no alarms or feedback; (2) an individual feedback group (n = 36) that received a daily alarm and a weekly medication adherence feedback report; and (3) a partner feedback group (n = 54) that received an alarm and a weekly feedback report that was shared with a friend, family member, or a peer. The intervention continued for 3 months, and participants were followed for an additional 3 months after the intervention period.


METHODS
Adherence as measured by pill bottle. Secondary outcomes included change in LDL (mg/dl), patient activation, and social support.


RESULTS
During the 3-month intervention period, medication adherence was higher in both feedback arms than in the control arm (individual feedback group 89 %, partner feedback group 86 %, control group 67 %; p < 0.001 and = 0.001). At 6 months, there was no difference in medication adherence between either of the feedback groups and the control (individual feedback 60 %, partner feedback 52 %, control group 54 %; p = 0.75 and 0.97).


CONCLUSIONS
Daily alarms combined with individual or partner feedback reports improved statin medication adherence. While neither an individual feedback nor partner feedback strategy created a sustainable medication adherence habit, the intervention itself is relatively easy to implement and low cost.
Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA. reddya@uw.edu.|UW Medicine Center for Scholarship in Patient Care Quality and Safety, Seattle, WA, USA. reddya@uw.edu.|Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Suite BB1240, Box: 356526, Seattle, WA, 98195-6526, USA. reddya@uw.edu.
Ashok
A
Reddy
VISN 4 Center for Evaluation of PACT, Philadelphia VA Medical Center, Philadelphia, PA, USA.
Tiffany L
TL
Huseman
VISN 4 Center for Evaluation of PACT, Philadelphia VA Medical Center, Philadelphia, PA, USA.
Anne
A
Canamucio
School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA.
Steven C
SC
Marcus
VISN 4 Center for Evaluation of PACT, Philadelphia VA Medical Center, Philadelphia, PA, USA.|Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.|Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
David A
DA
Asch
VISN 4 Center for Evaluation of PACT, Philadelphia VA Medical Center, Philadelphia, PA, USA.|Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.|Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Kevin
K
Volpp
VISN 4 Center for Evaluation of PACT, Philadelphia VA Medical Center, Philadelphia, PA, USA.|Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.|Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Judith A
JA
Long
D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000188:drug therapy; D004349:Drug Packaging; D005246:Feedback; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D017010:Reminder Systems; D012944:Social Support; D016903:Drug Monitoring
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
medication adherence; social force; social support; statins