Table 1. Study sample and intervention characteristics of the included studies.
| Study population characteristics | Intervention characteristics | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| First author,year of publication | Indication | IGa (n) |
CGb (n) |
Loss to follow-up (%) | Device | Study duration (weeks) | Number of interventions | Feedback provider | Mean duration single intervention (min) | Description of the intervention (feedback) |
| Onyirimba, 2003 [25] | Asthma | 30c | 37 | MDI Chronologs Model MC-311 | 10 | 4 | Clinician | 30–60 | Computer printout (date and time) | |
| Discussion about actuation data at every follow-up visit after a period of monitoring (1 or 3 weeks, non-instant feedback) | ||||||||||
| Direct clinician-to-patient feedback | ||||||||||
| Non-judgmental discussion of results (constructive and positive) emphasising techniques and strategies to improve adherence | ||||||||||
| Schmitz, 2005 [26] | Smoking cessation | 51 | 46 | 53 | MEMS® cap (without digital displays) | 7 | 7 | Clinical nurse | 5–10 | Graphic feedback after one week of monitoring (repeated) |
| Feedback between patient and provider (non-instant feedback) | ||||||||||
| Repeating instructions for improving adherence | ||||||||||
| Check medication side effects | ||||||||||
| De Geest, 2006 [27] | Renal transplantation | 6 | 12 | 28 | Electronic device, not specified | 13 | 4 | Nurse | NA | Graphic and tabulated feedback (printouts) at the end of the month for three consecutive months |
| Problem detection, proxy goal setting and regular targeted feedback | ||||||||||
| Discussion about possible factors related to non-adherence, self-efficacy interventions | ||||||||||
| Individualised intervention strategies (refreshment course, possible behavioural interventions and social support interventions that were based on an individualised assessment of reasons for non-adherence) | ||||||||||
| One home visit, three follow-up calls by telephone | ||||||||||
| Mooney, 2007 [28] | Smoking cessation | 27 | 28 | 56 | MEMS® cap (not specified) | 6 | 6 | Therapist | +10d | Graphic feedback based on individual cognitive behavioural therapy (CBT) |
| Weekly feedback by a provider based on previous monitoring (non-instant feedback) | ||||||||||
| Reviewing and clarifying the treatment regimen | ||||||||||
| Problem-solving techniques to help the participant tailor the medication regime | ||||||||||
| Identification of potential barriers and discussion about strategies to remove these barriers | ||||||||||
| Encouraging patients to self-monitor pill consumption (daily diary) | ||||||||||
| Evaluation self-monitoring at the next therapy session | ||||||||||
| Santschi, 2008 [29] | Hypertension | 34 | 34 | NA | MEMS® cap (not specified) | 52e | 4e | Pharmacist | NA | Adherence report (printout) |
| Discussion of the electronically recorded results over the past 2 months (non-instant feedback) | ||||||||||
| In case of substantial drug omissions, GP and pharmacist explored ways to improve medication adherence with the patient. | ||||||||||
| Sabin, 2010 [30] | HIV positive | 34 | 34 | 6 | Med-ic™ pill bottle | 26 | 6 | Physician/ nurse | 10–15 | Graphic feedback (printout) |
| Feedback by a provider based on previous month’s electronic drug monitor data (repeated, non-instant feedback) | ||||||||||
| ‘Flagged’ for counselling with a physician or nurse in case of adherence levels <95% | ||||||||||
| Individually-focused discussion (no script) | ||||||||||
| Questions focusing on missed or off-time doses, problems or challenges | ||||||||||
| De Bruin, 2010 [31] | HIV positive | 66 | 67 | 13 | MEMS® cap (including a 24h LCD readout) | 39 | 2 or more | HIV-nurse | NA | Graphic feedback |
| Discussion of MEMS reports after a 3-month intervention period (non-instant feedback) | ||||||||||
| Instant feedback by a MEMS-view-cap during the 2 to 4-month follow-up period | ||||||||||
| ‘Minimal intervention’: feedback of MEMS reports, reinforcement, and brief discussion about any difficulties that could be solved | ||||||||||
| ‘Full intervention’: increase knowledge, correct misconceptions when relevant, select a desired yet feasible adherence level including motivation for this choice, discussion about difference between actual and desired adherence status, identifying causes for non-adherence and tailored solutions for these problems, goal setting, option to self-monitor medication intake during the upcoming period to identify challenging situations and to develop solutions to cope with challenges. | ||||||||||
| Brath, 2013 [32] | Patients at risk for cardiovascular conditions (at least two out of three health risks: type 2 diabetes, hypertension, hypercholesterolaemia) | 77 (crossover design) | 31 | Electronic medication blister (OtCM, DSM TCG B.V.) | 52 | Depends on individual adherence level | Study coordinator | NA | Adherence data were transmitted wirelessly by a NFC-enabled reader device (mobile phone) | |
| A web-based telehealth system analysed the received data | ||||||||||
| Processed data were used to remind patients automatically via SMS messages | ||||||||||
| Data were presented to the study physician numerically and graphically via browser-based user interface | ||||||||||
| SMS reminders to remind patients to transmit data regularly and on time (instant feedback) | ||||||||||
| Subjects with minor adherence (<70% of prescribed drugs taken) were contacted by a study coordinator once a week trying to increase adherence motivation (phone call, non-instant feedback) | ||||||||||
| Forni Ogna, 2013 [33] | Secondary hyperparathyroidism | 24 | 26 | 18 | MEMS® Smartcap (including a 24h LCD readout) | 26 | 3 | Nephrologist | NA | Graphic feedback |
| Feedback by a provider after 2 months of monitoring (repeated, non-instant feedback) | ||||||||||
| Instant feedback by a 24h LCD readout MEMS cap | ||||||||||
| Semi-structured motivational interviews | ||||||||||
| Questions focusing on experience and complications with medication-intake | ||||||||||
| Identification potential barriers and generation of strategies to overcome barriers | ||||||||||
| Elaboration and evaluation individualised adherence plan | ||||||||||
| Dobbels, 2017 [34] | Heart, liver and lung transplant recipients | 103 | 102 | 21 | Helping Hand | 26 | 2 | Nurse with a Master in Nursing Science | NA | Graphic feedback (printouts of the 3-month monitoring period preceding the study visit) in a non-judgmental way delivered by the intervention giver (non-instant feedback) |
| Patients with good implementation of medication regimen based on printouts of Helping Hand: social support (emotional), problem solving (including relapse prevention and coping planning) | ||||||||||
| Patients with poor implementation of medication regimen based on printouts of Helping Hand: assessment of patient’s level of motivation using a 10-point importance and confidence ruler | ||||||||||
| Instant feedback: the Helping Hand reminder system consists of a beeping signal at time of scheduled medication intake | ||||||||||
| Instant feedback: the Helping Hand system provides visual signal feedback using a traffic light system (green, orange or red light) | ||||||||||
a number of included patients in the intervention group,
b number of included patients in the control group,
c allocation not mentioned,
d Additional time required for the intervention, excluding regular time for a consult,
e Depending on the results of office blood pressure (<140/90 mmHg) and adherence (≥80% taking adherence), the GP had the opportunity to continue or stop electronic monitoring. So, intervention period and follow-up period were variable. NA: not available