What a technical evaluation taught us about adherence as a behaviour

Pill Connect dispensers were recently deployed in a technical validation study to assess how accurately dosing events could be captured and timestamped in a home environment.

18 volunteers were asked to dispense BID for a couple of weeks. Clearly there are limitations so we’re not drawing broad conclusions, but there were still interesting insights into adherence as a behaviour.

When volunteers did miss a dispense, it rarely stopped at one. Lapses clustered and consecutive missed days led to longer periods of non-adherence. One volunteer self-corrected without any intervention. Poorer adherence at the start also matched with poorer adherence overall.

There are several adherence drivers in clinical studies and there were no interventions in this pilot. However, to me adherence seems like an underlying behaviour and I wonder how adherent one person is to one task compared to another. I would assume the considerable attention in a clinical trial helps maintain higher adherence than in a real-world task, so this data is interesting to examine still.

Examining this data shows why I believe Pill Connect dispensers are so useful. Adherence tells a story, clustering vs isolated, missing at the start or dropping off. But you only see this when you measure it.

The default measurement is a pill count, but that would have shown 6 pills remaining in a bottle for one volunteer. What it can’t do is show that those were 3 consecutive missed days rather than isolated doses widely spread out. In a real clinical setting and depending on the compound of course, it’s likely that one of those needs to trigger a more pressing intervention than the other.

Again, limitations aside, we can look at the 3 volunteers who missed their first 2 days; these went on to be the lowest adherers. Finding this out right away could open the door for intervention.

The difference in a real trial is what happens next now this data is available. With the complete dosing history available in real-time, intervention can be led by the teams directly working with participants. A site sees that adherence on the weekend is harder for this participant and that opens a discussion about why. Without the objective data, it’s a lot harder to have honest conversations around what’s actually happening.

Dosing at home shouldn’t be a blind spot to engagement and adherence. Pill Connect is actively illuminating this in clinical trials to protect endpoints.