• Judd B Kessler, Andrea B Troxel, David A Asch, Shivan J Mehta, Noora Marcus, Raymond Lim, Jingsan Zhu, William Shrank, Troyen Brennan, and Kevin G Volpp.
• Wharton School of the University of Pennsylvania, Philadelphia, PA, USA. judd.kessler@wharton.upenn.edu.
• J Gen Intern Med. 2018 Sep 1; 33 (9): 153615421536-1542.

BackgroundPoor medication adherence is common and limits the effectiveness of treatment.ObjectiveTo investigate how social supports, automated alerts, and their combination improve medication adherence.DesignFour-arm, randomized clinical trial with a 6-month intervention.ParticipantsA total of 179 CVS health employees or adult dependents with CVS Caremark prescription coverage, a current daily statin prescription, a medication possession ratio less than 80%, and Internet access.InterventionsParticipants were randomly assigned to control, social support (partner), automated adherence alert messages (alert), or both social support and alerts (partner + alert). Participants in the social support arms were asked to name a medication adherence partner (MAP) to help them take their medication. Participants in the alert arms were sent emails, text messages, or automated phone calls if they had failed to adhere on the previous day and on one or both of the 2 days before that. In partner + alert, both participants and fully enrolled MAPs received alerts.Main MeasuresAdherence measured by wireless pill bottle opening.Key ResultsCompared to 36.0% adherence in control, adherence was significantly greater in the alert arm (52.9%, difference vs. control of 17.0%, 95% CI for difference 6.3 to 27.6%, P = 0.002) and the partner + alert arm (54.5%, difference vs. control of 18.6%, 95% CI for difference 6.6 to 30.5%, P = 0.003). Adherence in the partner arm was not statistically significantly greater than control (43.2%, difference vs. control of 7.2%, 95% CI of difference - 5.2% to 19.5%, P = 0.25). There were no statistically significant differences among the three treatment arms. Fewer participants invited a MAP in the partner + alert arm than the partner arm (P = 0.02).ConclusionsAutomated alerts were effective at improving medication adherence. Assigning a medication adherence partner did not statistically significantly affect adherence rates.Trial RegistrationClinicalTrials.gov Number NCT01890018 [ https://clinicaltrials.gov /].

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