Electronic monitoring of adherence to multiple medications in cancer patients: Promise and challenges (Preprint)

BACKGROUND An electronic pillbox can serve as a tracking device for adherence to a complex medication regimen. Blood cancer patients receiving an allogeneic hematopoietic cell transplant (alloHCT), typically prescribed with multiple pills, can benefit from it. Their medication adherence plays a critical role in post-transplant survival, as it can help limit severe side effects and toxic drug interactions. However, existing studies report a wide range of adherence rates. OBJECTIVE Adherence to multiple medications is an important issue for patients with chronic conditions such as cancer but it remains understudied. An electronic pillbox can serve as tracking device for adherence to a complex medication regimen. The current mixed methods study in cancer patients who had received an allogeneic hematopoietic cell transplant (alloHCT) had three aims: (1) to test the feasibility of using an electronic pillbox for tracking a multiple-medication regimen in the first 180 days at home, (2) to describe sensor use and adherence levels, and (3) to capture patient experiences using the electronic pillbox. METHODS Cancer patients after alloHCT (n = 33) received an electronic pillbox at first discharge from hospital and were followed for 180 days. Data to calculate adherence was available for 27 individuals, and 28 patients participated in interviews about their experiences using the electronic pillbox. RESULTS Most patients used their pillbox immediately after discharge and continued using it beyond 180 days, with large variability in signal transmission rates. The average adherence score was 2.2, significantly lower than the prescribed at least four medication doses each day (P<.001) and indicating 55% adherence. In the interviews, patients reported ease of use and benefits of the electronic pillbox, but also challenges, such as the large size and limited battery life of the pillbox. CONCLUSIONS It is feasible to use an electronic pillbox for cancer patients taking multiple medications, although there is room for improvement in the pillbox design. Overall, patients had a positive experience using the electronic pillbox. A user-friendly device would have great potential for a multi-faceted, real-time intervention to facilitate adherence to multiple medication regimens.

A self-medication administration program for transplant recipients

Cardiothoracic transplant recipients must follow a complex medication regimen after discharge. Patients, particularly heart transplant recipients who have a shorter postoperative length of stay than other organ recipients, have a limited time to master this regimen. The SMAP has shown benefits in patients' mastery of medication information, increased patient satisfaction, better preparation for discharge, and home adjustment. The program offers a structured approach for teaching patients complex medication regimens.