Medication Adherence and Wearables Utilization - What's the link?
Wearables and Medications
What’s the connection?
Quisel T, Foschini L, Zbikowski SM, Juusola JL. The Association Between Medication Adherence for Chronic Conditions and Digital Health Activity Tracking: Retrospective Analysis. J Med Internet Res 2019;21(3):e11486
What's the hype about this article?
The amount of users of digital health wearables has grown from 2% to almost 30% of the US population in the past 7-years. I do a weekly review of what digital health pubs pop up on Pubmed and saw this last month, but due to a few colleagues and mass media uptake, I thought it may be good to do a deep dive into the article. The obvious huge factor why this article is garnering attraction is the push from insurers and payors for offering wearables for their members, and if it is demonstrated those using wearables have a higher medication adherence, it seems a good rationale to push that endeavor as it is a large billion dollar issue in the United States.
What was the study design?
The primary objective of this study was to identify the relationship between digital activity-tracking and medication adherence (in patients with DM, dyslipidemia, and HTN), and whether their utilization impacts medication adherence.
The study was designed around a retrospective analysis of data from Humana involving medical and pharmacy claims data from January 1, 2015, until June 1, 2016. Patients were included in the analysis if they had 1 of 3 medical conditions (diabetes, dyslipidemia, or HTN) based on ICD codes. Now, in order to set-up determing adherence, they looked at a supply period (3 months early 2015) and establish baselines, then they analyzed data for a 12-month period (June 2015-June 2016) to track refill rates. In essence, the adherence was tracked by MPR/PDC in a fashion. Adherence was set up based on the researcher's methods as any PDC>0.80 in the least 1-drug class level then being adherent.
Patients who had a wearable device were included in a sub-sample group, and this led to other objective data tracking measurements (e.g., steps, sleep, dietary logs). They then set up a methodology to determine high and low users of wearable devices. No citations affiliated if this is their own methodology or was borrowed from someone else.
Finally, a logistic regression was used to assess adherence between those with a wearable and not. A total of 7 models were utilized taking into consideration different use of wearables and metrics.
What were the results?
A total of 117,765 (DM), 317,340 (dyslipidemia), and 673,428 (HTN) were identified and included in the PDC analysis. PDC data were similar across the conditions, though the variable PDC had some different results. A total of 8553 patients were found to utilize a wearable and included in the analysis. More than 75% used a Fitbit device, followed by Garmin and Jawbone and Apple Products. Tracking was utilized primarily amongst those <50yrs.
The authors found that those tracking 1 of 4 activities with a wearable were more adherent based on PDC data. By and large, this was seen across different models accounting for different conditions and activities.
What were the authors' thoughts?
The authors wrote that their study demonstrated a significant relationship between medication adherence and the use of a wearable in patients with a chronic condition. This was further seen when activity levels increased amongst patients. They identified that their results could be used by payors addressing medication adherence programs for members, or for use in clinical trials or chronic disease management programs. They also identified that a 'Healthy adherer' may be a thing, whereby healthier people are more likely to be adherent to medications than unhealthy people.
My thoughts and implications to pharmacy and clinical practice
Overall, rather interesting paper. To my knowledge, I have not seen any research tying together wearable use and medication adherence at this point. I think it is in the right direction. The biggest concern for those reading this paper is that it is a retrospective study and those have some inherent limitations. PDC data I am not a big believer in, but for wide-scale studies like this, it probably is the only feasible mechanism to get it done. The study also is a bit dated (2015-2016) as we are now seeing a higher use of smartwatches which have supplanted the Garmin and Jawbone (extinct) market.
This is a sticking point for me as I would be inclined to believe that early adopters or wearables are 'Health adherers' to therapy, and it would make sense that those that were more physically active and tracking health metrics would be adherent to their therapy, versus those that are not. However, with the growth of smartwatches and such, can that still be a postulation? It wouldn't be surprising to me if the apple watch and payor studies look to confirming the results of this study.
Lastly, we still do not know if this does lead to better patient outcomes, and that will be the lynchpin. The data looks favorable, so either an RWE study by a payor or an RCT will likely have to be done to see how this all pans out. My thoughts are that we can use this data to help with what the authors identified, but also wearables would probably be better used to identify those with poor health behaviors and intervene more on those than opposite at this time, and handing out wearables to get people to be adherent to therapy should not be the takeaway point.