Supposed to improve treatment adherence, digital tools disappoint

Digital medicine, connected objects, new technologies, many names designate tools that aim to better measure and improve patient adherence to treatment. As nearly one in two chronically ill patients violate medical prescriptions, the need to quantify the incidence in clinical trials is also important. How can we evaluate the effectiveness of antibiotics, painkillers or chemotherapy if the drugs are not taken correctly?

These techniques are very diverse. In addition to simple alarms on your smartphone, like a knot on your napkin, there are numerous apps that send notifications (sound signals, messages, etc.) to take medication. But a review of thirteen studies published in 2017 found no conclusive evidence of improved adherence to medications prescribed for diabetes or high blood pressure through digital health interventions such as texting.

“These tools may be interesting to improve inadvertent non-adherence (forget)For example during the first prescription of the contraceptive pill for young women »Explains Stephanie Siedorkiewicz, University Lecturer in General Medicine at Paris City University, who did her thesis on this topic in 2017.

A connected pillbox

“Several studies have shown improvements in treatment uptake by automated SMS, such as in the case of antiplatelet drugs after myocardial infarction or, in Africa, in the monitoring of antiviral or anti-tuberculosis treatment”For their part, Nicolas Postel-Vinay, a specialist in arterial hypertension at the Georges-Pompido European Hospital (AP-HP), and his colleagues, in an article published in the journal Medicine/ScienceIn September 2018.

Appearing in the 1990s, electronic pill dispensers did not constitute the declared revolution. “Their use has not entered current practice, and the studies, few in number, are rarely conclusive”, explains Nicolas Postel-Vinay. Recently a Montpellier start-up Launched Thess (Therapy Smart System), which consists of a pill dispenser connected to a hospital platform designed for oncology or post-transplant patients undergoing treatment at home. This tool allows you to check treatment adherence. Likewise, the patient may report adverse effects. If necessary, it is possible to adapt the dose delivered by the pill dispenser.

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