Meg Brunner, MLIS
CTN Dissemination Library
Patients taking medications for health-related conditions sometimes have difficulty remembering to take their doses, negatively impacting their outcomes.
In research settings, non-adherence to medication regimens can make it harder for scientists to properly evaluate targeted outcomes and draw appropriate conclusions. Having participants self-report their own behavior is not always reliable, especially when lacking corroborating measures.
When a study is being conducted over a short period of time and with few participants, high medication adherence and timely monitoring and correction of nonadherence is even more important. For that reason, researchers involved in the NIDA Clinical Trials Network study CTN-0054: Accelerated Development of Additive Pharmacotherapy Treatment (ADAPT) for Methamphetamine Use Disorder decided to use a new technique to collect dosing information: smartphone “selfie” videos.
This article describes how smartphones were used to monitor and encourage medication taking, and reports on the feasibility, utility, and acceptability of the technology and approach from the perspectives of both study participants and staff.
CTN-0054 was an 8-week study evaluating the use of extended-release injectable naltrexone combined with once-daily oral extended-release bupropion (BRP, Wellbutrin XL) for the treatment of methamphetamine use disorder. Participants went to the clinic twice a week for observed BRP dosing, assessments, and medical management. On non-clinic days, they were expected to take their BRP doses on their own. Medication adherence was assessed objectively, by observation at the clinic and smartphone videos for dosing at home, and subjectively, by participant self-report.
For the videos, participants were provided with a smartphone that allowed for phone, text, and internet service. They were instructed on how to record themselves taking their medication using the phone’s forward-facing camera, and the phone was configured to transmit videos to the study server automatically. Participants received $10 for every valid dosing video submitted, and those who completed the study were allowed to keep the phone or return it and receive an additional $30.
Participants (N=49) reported taking 93.6% of the dispensed BRP doses, while 86.6% of dispensed doses were confirmed via dosing videos and in-person observation. Most participants agreed that the smartphone was easy to use (92.6%) and that taking the dosing videos helped them remember to take the study medication (80.5%).
In addition to helping collect accurate dosing data, the use of smartphones also addressed other common logistical challenges for researchers and study participants. For example, it:
Conclusions: The ADAPT pilot study was the first trial that utilized a smartphone-enabled, video confirmation strategy to remotely monitor and encourage oral medication adherence among people who use methamphetamine. The smartphone method was found to be a feasible and acceptable way to encourage, monitor, and confirm that participants took their doses. Video-confirmed dosing adherence provides an objective indicator of the lowest medication adherence rate participants achieve, allowing study investigators to more confidently interpret results. The use of smartphones in this study also helped address common logistical challenges with study participants, and may have served as an incentive to remaining in the trial.
Citation: Walker NR, et al. Medication Adherence Monitoring Using Smartphone Video Dosing in an Open-label Pilot Study of Monthly Naltrexone Plus Once-daily Bupropion for Methamphetamine Use Disorder: Feasibility and Acceptability. Journal of Addiction Medicine 2019 (in press).
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