SAN DIEGO—The use of pillboxes and other medication management aids by patients with Parkinson’s disease may not be associated with increased medication adherence, according to research presented at the 65th Annual Meeting of the American Academy of Neurology. Patients who relied on cell phone alarms had worse adherence to their medication.
“Medication adherence aids—particularly phone alarms—do not magically improve adherence to medication regimens,” cautioned Melissa Armstrong, MD, Assistant Professor of Neurology at the University of Maryland Medical Center in Baltimore.
“I still encourage my patients to use various aids, especially since we don’t have anything better. But I caution them that they shouldn’t think these aids are going to miraculously help them remember to take their doses. It’s still going to take commitment and work. I particularly caution my younger Parkinson’s disease patients using phone alarms that they need to choose good ringtones, be attentive to the reminders, and be careful not to just switch off the phone alarm and proceed on with their day without taking their medications,” she added.
Gauging the Efficacy of Various Medication Aids
In a study conducted at the University of Maryland’s Parkinson’s Disease and Movement Disorders Center in Baltimore, Dr. Armstrong and her associates sought to determine how often patients with Parkinson’s disease use medication management aids and to evaluate whether the use of such aids was associated with improved adherence.
“There is little work on this in Parkinson’s disease, despite the complex medication regimens that people with Parkinson’s disease have,” said Dr. Armstrong. “Also, from a clinical perspective, physicians at our movement disorders center realized that we didn’t know how many of our patients were already using different aids to help them remember to take their medications. We thus decided to investigate what our patients are already trying and whether the aids are helping.”
Patients who had had Parkinson’s disease for at least one year and who were responsible for managing their own medications were eligible for the trial. Referring physicians completed the Unified Parkinson’s Disease Rating Scale, and study participants completed the Montreal Cognitive Assessment, a medication adherence aid questionnaire, and the eight-item Morisky Medication Adherence Scale (MMAS-8).
The mean age of study participants was 69. Approximately 67% of patients were male, and 93% were white. Patients took an average of 2.4 Parkinson’s disease drugs and an average of 6.9 total drugs.
Most Patients Followed Their Drug Regimens
Of the 104 patients, 78% adhered to their medications, as indicated by a score of 0 to 3 on the MMAS-8, and 77 (74%) reported use of one or more aids to manage their medications. These aids were chiefly pillboxes (used by 70 patients, 55 of whom met adherence criteria), cell phone alarms (used by 10 patients), watch alarms (used by seven patients), and pillboxes with alarms (used by six patients). Twenty-seven patients used no adherence aid.
Overall, Dr. Armstrong and her associates found that 52 (68%) of the 77 patients who used an adherence aid met adherence criteria. Adherence aids were not significantly associated with improved medication adherence, however. Cell phone alarms worsened adherence; five of 10 patients who used this device met adherence criteria. The poor adherence associated with cell phone alarms “could be because phones are easy to turn off without further response and because mobile phone sounds are so frequent they are not effective,” said Dr. Armstrong. “Future research is needed to investigate the relationship between cell phone alarm use and adherence, especially as their use increases.”
Dr. Armstrong noted that the relatively small sample size is a limitation of the study.
—Doug Brunk
IMNG Medical News
Suggested Reading
Allen NE, Sherrington C, Suriyarachchi GD, et al. Exercise and motor training in people with Parkinson’s disease: a systematic review of participant characteristics, intervention delivery, retention rates, adherence, and adverse events in clinical trials. Parkinsons Dis. 2012;2012:854328.
Daley DJ, Myint PK, Gray RJ, Deane KH. Systematic review on factors associated with medication non-adherence in Parkinson’s disease. Parkinsonism Relat Disord. 2012;18(10):1053-1061.