Electronic Reminders Improve Tuberculosis Medication Adherence

Electronic reminders conveyed to tuberculosis (TB) patients in China can reduce the amount of medication doses they miss by half, according to a new study.

Researchers at the Chinese Center for Disease Control and Prevention (CCDC; Beijing, China), the London School of Hygiene & Tropical Medicine (LSHTM; United Kingdom), and other institutions conducted a trial involving 4,173 patients from the Chinese provinces of Heilongjiang, Jiangsu, Hunan, and Chongqing, whom either received text message reminders, an electronic medication monitor, both, or no reminders at all. In all arms, patients took medications out of a medication monitor box, which recorded when the box was opened.

The results showed that patients receiving no reminders missed taking 29.9% of their medication doses, while patients receiving text messages missed 27.3% of their doses. However, the patients with an electronic medication monitor box that beeped if not opened at the agreed time only missed 17% of their medication doses. And those patients who received both text messages and a beeping electronic medication monitor missed just 13.9% of medication doses. The study was published on September 15, 2015, in PLOS Medicine.

“Global plans to reduce TB advise that treatment be taken under the direct observation of a healthcare worker to reduce missed doses, something which has been difficult to carry out in many parts of China, particularly in rural areas, as in other parts of world,” said senior author Katherine Fielding, MD, of the LSHTM. “Our findings show real promise. A low-cost, reliable electronic medication monitor could improve TB treatment for thousands of people across China.”

“Directly observed therapy is difficult to implement in China due to limited human resources, poor acceptance and other factors. Our study aimed to assess whether the use of the medication monitor and/or text messaging can improve adherence to TB drugs,” said lead author Shiwen Jiang, MD, of the CCDC National Center for Tuberculosis Control and Prevention. “We are currently planning a further evaluation of a management model, including the use the medication monitor on long-term TB outcomes including TB recurrence. China plans to scale up the use of medication monitors in some provinces in the next five years.”

TB treatment usually lasts for six months and is effective if taken fully, but patients missing drug treatment doses can cause major problems by increasing the risk of having a relapse of TB, and also of the TB becoming drug resistant, making it more difficult to treat and potentially fatal. To improve medication adherence, the World Health Organization (WHO, Geneva, Switzerland) recommends health care workers supervise patients while they take their medication. This can be hard to implement, especially in China, and the national tuberculosis control policy therefore permits self-administered treatment and treatment monitored by family members.

Related Links:
Chinese Center for Disease Control and Prevention
London School of Hygiene & Tropical Medicine
World Health Organization