Can Technology Solve the Problem of Medication Nonadherence?

Evaluating Strategies for Enhancing Medication Adherence in the Kingdom of Saudi Arabia (KSA): A Cross-Sectional Study

Purpose

This study aimed to assess medication adherence strategies among users in Saudi Arabia, explore the prevalence and effectiveness of behavioral, technical, and organizational tools, and identify key predictors of adherence related to demographic, health, and medication characteristics.

Patients and Methods

A descriptive cross-sectional study was conducted among 250 Saudi residents aged ≥18 who regularly take prescription/non-prescription medications. The questionnaire was developed through a literature review, validated by academic pharmacists, and refined based on pilot testing feedback. A convenience sampling method, complemented by snowball sampling, was employed to recruit participants. Limitations like sampling bias and self-reported data emphasize the need for broader studies. Quantitative analysis was performed using IBM SPSS.

Results

Participants were predominantly young adults (84%) and females (84%), with 54% reporting being healthy and 46% managing chronic conditions. Behavioral strategies, such as time-based reminders, were the most commonly used (40%), followed by technical tools (33%), including mobile applications. Employment status significantly influenced adherence, with employed individuals (adjusted OR: 3.274, p = 0.028) and those working >8 hours daily (adjusted OR: 9.838, p = 0.049) exhibiting higher adherence. Fieldwork negatively impacted adherence (adjusted OR: 0.052, p = 0.007). While other demographic and health factors showed no significant associations, trends suggested that complex medication regimens increased the likelihood of using adherence strategies.

Conclusion

Behavioral strategies, such as time- and location-based reminders, and technical tools, like apps, effectively improved medication adherence. Healthcare providers should promote simple, cost-effective methods, such as pillboxes and mobile reminders, tailored to patient needs. Addressing adherence barriers for individuals with demanding/unexpected schedules or complex regimens through targeted interventions and awareness campaigns is essential. Future research should explore these strategies' scalability and long-term impact in diverse healthcare settings.

The Impact of Home Medication Management Practices on Medication Adherence

Medication adherence is a vexing challenge, with over 50% of US adults not adhering to their prescribed medication regimen. Most medications are self-administered by patients at home, requiring them to independently develop and manage their own medication routines. By understanding these home-based practices, such as where patients store their medications and how different storage locations impact adherence, we can develop targeted interventions to improve adherence rates. Our goal was to identify and categorize self-reported home medication management practices and determine which practices are associated with self-reported medication adherence. From the 1673 total survey respondents we learned that the most common places people store their medications at home are nightstand drawers (28%), on top of nightstands (27%), kitchen cabinets (22%), and bathroom medicine cabinets (20%). Kitchen cabinets and bathroom vanities were significantly associated with increased odds of having ever forgotten to take a medication. On the other hand, desks, dining room tables, and the inside of nightstand drawers were associated with the greatest statistically significant decrease in odds of having ever forgotten to take a medication. Almost all (96%) respondents were receptive to receiving guidance from healthcare providers on how to store medications. Patients are largely responsible for creating their own home medication management practices, including deciding where to store their medication at home. Understanding which home storage locations are associated with medication adherence can lead to innovative approaches to improve adherence, including personalized guidance to patients from their healthcare providers for patients.

Medication Management Strategies to Support Medication Adherence: Interview Study With Older Adults

BACKGROUND

Home medication management has been insufficiently studied, including the factors that impact the development and effectiveness of adherence strategies under both routine and anomalous circumstances. Older adults are a particularly important population to study due to the greater likelihood of taking medication in combination with the desire to "age in place."

OBJECTIVE

This interview study aims to understand how older adults develop medication management strategies, identify when and why such strategies succeed or fail, learn more about how older adults think about their medication, and explore interventions that increase medication adherence.

METHODS

This study used a qualitative, semistructured interview design to elicit older adults' experiences with home medication management. Overall, 22 participants aged ≥50 years taking 1 to 3 prescription medications were recruited and interviewed. Interview responses were recorded, and thematic, qualitative analysis was performed by reviewing recordings and identifying recurring patterns and themes. Responses were systematically coded, which not only facilitated the identification of these themes but also allowed us to quantify the prevalence of behaviors and perceptions, providing a robust understanding of medication management and medication adherence.

RESULTS

Participants reported developing home medication management strategies on their own, with none of the participants receiving guidance from health care providers and 59% (13/22) of the participants using trial and error. The strategies developed by study participants were all unique and generally encompassed prescription medication and vitamins or supplements, with no demarcation between what was prescribed or recommended by a physician and what they selected independently. Participants thought about their medications by their chemical name (10/22, 45%), by the appearance of the pill (8/22, 36%), by the medication's purpose (2/22, 9%), or by the medication's generic name (2/22, 9%). Pill cases (17/22, 77%) were more popular than prescription bottles (5/22, 23%) for storage of daily medication. Most participants (19/22, 86%) stored their pill cases or prescription bottles in visible locations in the home, and those using pill cases varied in their refill routines. Participants used ≥2 routines or objects as triggers to take their medication. Nonadherence was associated with a disruption to their routine. Finally, only 14% (3/22) of the participants used a time-based reminder or alarm, and none of the participants used a medication adherence device or app.

CONCLUSIONS

Participants in our study varied considerably in their home medication management strategies and developed unique routines to remember to take their medication as well as to refill their pill cases. To reduce trial and error in establishing a strategy, there are opportunities for physicians and pharmacists to provide adherence guidance to older adults. To minimize the impact of disruptions on adherence, there are opportunities to develop more durable strategies and to design aids to medication adherence that leverage established daily routines.