Reminding to take medicines: supporting adherence

Managing forgetfulness

Individuals can have varying levels of difficulty remembering to take their medicine(s). This could be due to health conditions or for no specific reason at all.

It is important to consider what patients are currently doing to help them remember to take their medicines before providing alternative advice.

Simplifying medication regimens

There is evidence that reducing the number or frequency of medicines where possible can improve adherence. Healthcare professionals may find the SPS resources on polypharmacy useful when undertaking medication review.

Reminder systems

Evidence shows that simple reminders can help, but greater benefit is seen when reminders are combined with active follow-up from healthcare professionals.

Encourage patients to take the lead in describing their daily routine. Support them to consider how they can more easily fit taking their medicines into their routine.

Reminder systems that can help include:

• positioning medicines in visible places (such as morning medicines near the toothbrush or kettle)
• associating medicine-taking with meals or other regular daily activity
• fridge stickers or magnets

Telephone or text reminders

Telephone reminders from family, friends, carers or organised through telecare companies could help people remember to take medicines. There must be a robust system in place to inform those reminding the patient about changes to medicines.

Evidence suggests text messages or telephone reminders are most effective when they are personal or interactive, whilst electronic drug monitors are unlikely to improve adherence without additional support from healthcare professionals.

Telepharmacy services

Interventions using technology to allow pharmacist and patient interactions from a distance are called telepharmacy services. Examples include using video conferencing software or having telephone consultations.

Evidence shows these interventions can lead to improved medication adherence, improved patient satisfaction and reduced adverse events.

Telepharmacy services show adherence support no longer needs to be delivered face-to-face. When choosing a suitable method, it is important that patient preference is considered. Video calls may be useful for demonstrating techniques, but phone calls may be more convenient for patients.

Medication reminder charts

Medication reminder charts summarise a patient’s medicines, what they are for, and how to take them.

Computer-generated charts

Computer-generated reminder charts are practical and cost effective and some pharmacies offer them free-of-charge. They can generally be produced using pharmacy dispensing systems and system providers can demonstrate how to use this functionality.

Alarm devices

Numerous alarm devices are available. It is important patients are assessed for suitability for having these, since sudden noises or vibrations may not be appropriate for all patients. A small selection of different devices is presented here.

Talking watches

A variety of alarms are available to buy, such as those from the Talking Watch Shop. These devices allow a number of alarms to be pre-set and are accessible for people who are blind or have visual impairment.

Audible or vibrating alarm watches

A variety of vibrating watches are available from retailers such as Malem Medical Ltd, Pivotell and TabTime. These devices allow a number of daily audible and vibrating alarms to be programmed. They may benefit people who are deaf or have hearing loss.

Programmable voice reminder

Voice reminders can be a useful aid for those with cognitive difficulties who can carry on living independently, if they are prompted to perform regular and occasional tasks by a familiar voice.

The Mem-X Voice Reminder from AlzProducts.co.uk can store up to 90 messages, each up to 10-seconds long. An alarm is triggered at the pre-set times to prompt the user to play the pre-recorded message.

Automatic medication dispensers

These devices are programmable to open sections at certain times of the day and can be accompanied by an alarm. They may be suitable for patients with stable yet somewhat complex medication regimens. There is some evidence to support their use. However, it is important that patients are assessed for suitability for having these devices as some can be complex to use and fill.

A range of battery operated, programmable medication dispensers with audio, visual or vibrational alarms are available from retailers such as Pivotell, Medimax, Lifemax and TabTime.

Before using any devices where medicines are stored outside of their original packaging, patients or health and social care professionals should consult a pharmacist regarding any potential medication stability concerns. Hospital pharmacies may not be familiar with these devices, which can cause confusion and potentially delay discharge.

Pill bottle top with indicator and alarms

Pill bottle cap timers feature a number of daily alarms that automatically indicate the last time the bottle was opened, time of day, AM or PM, and the day of the week. Some caps also fit onto a standard 33mm thread pill bottle but are not child proof.

Smart phone medication reminders

There are many medication reminder smart phone applications (‘apps’) available. Most apps send notifications to remind users to take their medicines at scheduled times throughout the day. However, evidence suggests that people are more likely to remember to take medicines when they link them to a regular daily activity rather than a specific time. People may also benefit from multiple reminders or cues. For best results, medication reminder apps should be used alongside support from healthcare professionals.

The quality and integrity of information in these apps can vary and some have been criticised for presenting inadequate or inaccurate health information that may deviate from evidence-based recommendations, as well as violations of privacy.

Features associated with higher quality medication reminder apps include:

• reliable content
• availability on Android and iOS platforms
• text or other medication recognition systems
• alerts for caregivers and useful features such as capacity to schedule dosing regimens and back up capabilities

However, some of the ‘convenient’ features might introduce risks and patients may want to look at multiple options before deciding on one that could help them.

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