Effect of Reminder Devices on Medication Adherence: The REMIND Randomized Clinical Trial
Open accessAbstract
Importance: Forgetfulness is a major contributor to nonadherence to chronic disease medications and could be addressed with medication reminder devices. Objective: To compare the effect of 3 low-cost reminder devices on medication adherence. Design, Setting, and Participants: This 4-arm, block-randomized clinical trial involved 53 480 enrollees of CVS Caremark, a pharmacy benefit manager, across the United States. Eligible participants were aged 18 to 64 years and taking 1 to 3 oral medications for long-term use. Participants had to be suboptimally adherent to all of their prescribed therapies (with a medication possession ratio of 30% to 80%) in the 12 months before randomization. Participants were stratified on the basis of the medications they were using at randomization: medications for cardiovascular or other nondepression chronic conditions (the chronic disease stratum) and antidepressants (the antidepressant stratum). In each stratum, randomization occurred within blocks defined by whether all of the patient's targeted medications were dosed once daily. Patients were randomized to receive in the mail a pill bottle strip with toggles, digital timer cap, or standard pillbox. The control group received neither notification nor a device. Data were collected from February 12, 2013, through March 21, 2015, and data analyses were on the intention-to-treat population. Main Outcomes and Measures: The primary outcome was optimal adherence (medication possession ratio ≥80%) to all eligible medications among patients in the chronic disease stratum during 12 months of follow-up, ascertained using pharmacy claims data. Secondary outcomes included optimal adherence to cardiovascular medications among patients in the chronic disease stratum as well as optimal adherence to antidepressants. Results: Of the 53 480 participants, mean (SD) age was 45 (12) years and 56% were female. In the primary analysis, 15.5% of patients in the chronic disease stratum assigned to the standard pillbox, 15.1% assigned to the digital timer cap, 16.3% assigned to the pill bottle strip with toggles, and 15.1% assigned to the control arm were optimally adherent to their prescribed treatments during follow-up. There was no statistically significant difference in the odds of optimal adherence between the control and any of the devices (standard pillbox: odds ratio [OR], 1.03 [95% CI, 0.95-1.13]; digital timer cap: OR, 1.00 [95% CI, 0.92-1.09]; and pill bottle strip with toggles: OR, 0.94 [95% CI, 0.85-1.04]). In direct comparisons, the odds of optimal adherence were higher with a standard pillbox than with the pill bottle strip (OR, 1.10 [95% CI, 1.00-1.21]). Secondary analyses yielded similar results. Conclusions and Relevance: Low-cost reminder devices did not improve adherence among nonadherent patients who were taking up to 3 medications to treat common chronic conditions. The devices may have been more effective if coupled with interventions to ensure consistent use or if targeted to individuals with an even higher risk of nonadherence. Trial Registration: clinicaltrials.gov Identifier: NCT02015806.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Interventions may include reminders or alarms to target forgetting, but evidence for the efficacy of reminders on adherence is limited (Choudhry 2017).
“Interventions may include reminders or alarms to target forgetting, but evidence for the efficacy of reminders on adherence is limited (Choudhry 2017).”
From Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis (2023) · cites this paper as Choudhry 2017
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Update on Key Emerging Challenges in Cystic Fibrosis
Jennings, M. T., Riekert, K. A., & Boyle, M. (2014) · Medical Principles and Practice · doi:10.1159/000357646 · Cited by 3,667 · see citing works
Trends in Prescription Drug Use Among Adults in the United States From 1999-2012
Kantor, E. D., Rehm, C. D., Haas, J. S., Chan, A. T., & Giovannucci, E. L. (2015) · JAMA · doi:10.1001/jama.2015.13766 · Cited by 1,219 · see citing works
Methods for evaluation of medication adherence and persistence using automated databases
Andrade, S. E., Kahler, K. H., Frech, F. H., & Chan, K. A. (2006) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.1230 · Cited by 1,077 · see citing works
Hess, L. M., Raebel, M. A., Conner, D. A., & Malone, D. C. (2006) · Annals of Pharmacotherapy · doi:10.1345/aph.1h018 · Cited by 759 · see citing works
Viswanathan, M., Golin, C. E., Jones, C. D., Ashok, M., Blalock, S. J., Wines, R. C. M., Coker-Schwimmer, E. J. L., Rosen, D. L., Sista, P., & Lohr, K. N. (2012) · Annals of Internal Medicine · doi:10.7326/0003-4819-157-11-201212040-00538 · Cited by 754 · see citing works
Full Coverage for Preventive Medications after Myocardial Infarction
Choudhry, N. K., Avorn, J., Glynn, R. J., Antman, E. M., Schneeweiß, S., Toscano, M., Reisman, L., Fernandes, J. F., Spettell, C. M., Lee, J. L.-Y., et al. (2011) · New England Journal of Medicine · doi:10.1056/nejmsa1107913 · Cited by 736 · see citing works
Self-citationVervloet, M., Linn, A. J., van Weert, J. C. M., de Bakker, D. H., Bouvy, M. L., & van Dijk, L. (2012) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2011-000748 · Cited by 455 · see citing works
Unintentional non-adherence to chronic prescription medications: How unintentional is it really?
Gadkari, A. S., & McHorney, C. A. (2012) · BMC Health Services Research · doi:10.1186/1472-6963-12-98 · Cited by 380 · see citing works
Factors associated with medication refill adherence in cardiovascular-related diseases
Gazmararian, J. A., Kripalani, S. B., Miller, M. J., Echt, K. V., Ren, J., & Rask, K. J. (2006) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2006.00591.x · Cited by 351 · see citing works
Intentional and Unintentional Nonadherence: A Study of Decision Making
Wroe, A. L. (2002) · Journal of Behavioral Medicine · doi:10.1023/a:1015866415552 · Cited by 284 · see citing works
Franklin, J. M., Shrank, W. H., Pakes, J., Sanfélix‐Gimeno, G., Matlin, O. S., Brennan, T. A., & Choudhry, N. K. (2013) · Medical Care · doi:10.1097/mlr.0b013e3182984c1f · Cited by 260 · see citing works
Self-citationCan long-term treatment with antidepressant drugs worsen the course of depression?
Fava, G. A. (2003) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v64n0204 · Cited by 223 · see citing works
Reminder packaging for improving adherence to self-administered long-term medications
Mahtani, K. R., Heneghan, C. J., Glasziou, P., & Perera, R. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005025.pub3 · Cited by 201 · see citing works
Electronic Medication Packaging Devices and Medication Adherence
Checchi, K. D., Huybrechts, K. F., Avorn, J., & Kesselheim, A. S. (2014) · JAMA · doi:10.1001/jama.2014.10059 · Cited by 198 · see citing works
Validity of a Prescription Claims Database to Estimate Medication Adherence in Older Persons
Grymonpre, R., Cheang, M., Fraser, M., Metge, C. J., & SITAR, D. S. (2006) · Medical Care · doi:10.1097/01.mlr.0000207817.32496.cb · Cited by 187 · see citing works
Awareness, Knowledge, and Attitudes of Older Americans About High Blood Pressure
Egan, B. M., Lackland, D. T., & Cutler, N. E. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.6.681 · Cited by 149 · see citing works
Petersen, M. L., Wang, Y., van der Laan, M. J., Guzman, D., Riley, E. D., & Bangsberg, D. R. (2007) · Clinical Infectious Diseases · doi:10.1086/521250 · Cited by 141 · see citing works
Zedler, B. K., Kakad, P. P., Colilla, S., Murrelle, L., & Shah, N. R. (2011) · Clinical Therapeutics · doi:10.1016/j.clinthera.2011.02.003 · Cited by 116 · see citing works
Tardive dysphoria: The role of long term antidepressant use in-inducing chronic depression
El‐Mallakh, R. S., Gao, Y., & Roberts, R. J. (2011) · Medical Hypotheses · doi:10.1016/j.mehy.2011.01.020 · Cited by 73 · see citing works
Franklin, J. M., Shrank, W. H., Lii, J., Krumme, A. A., Matlin, O. S., Brennan, T. A., & Choudhry, N. K. (2015) · Health Services Research · doi:10.1111/1475-6773.12310 · Cited by 58 · see citing works
Self-citationPredicting adherence trajectory using initial patterns of medication filling.
Franklin, J. M., Krumme, A. A., Shrank, W. H., et al. (2015) · PubMed · Cited by 51 · see citing works
Self-citationChoudhry, N. K., Isaac, T., Lauffenburger, J. C., Gopalakrishnan, C., Khan, N. F., Lee, M., Vachon, A., Iliadis, T. L., Hollands, W., Doheny, S., et al. (2016) · American Heart Journal · doi:10.1016/j.ahj.2016.07.017 · Cited by 33 · see citing works
Self-citationZimolzak, A. J., Spettell, C. M., Fernandes, J. F., Fusaro, V. A., Palmer, N., Saria, S., Kohane, I. S., Jonikas, M. A., & Mandl, K. D. (2013) · PLoS ONE · doi:10.1371/journal.pone.0079611 · Cited by 13 · see citing works
Choudhry, N. K., Krumme, A. A., Ercole, P. M., Girdish, C., Isaman, D. L., Matlin, O. S., Brennan, T. A., Shrank, W. H., & Franklin, J. M. (2015) · Contemporary Clinical Trials · doi:10.1016/j.cct.2015.05.006 · Cited by 10 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- [10]Choudhry NK, Krumme AA, Ercole PM, et al. Rationale and design of the Randomized Evaluation to Measure Improvements in Non-adherence from Low-Cost Devices (REMIND) trial. Contemp Clin Trials. 2015;43:53-59. [DOI] [PubMed] [Google Scholar]
Cited by
Sorted by citations
Choudhry, N. K., Kronish, I. M., Vongpatanasin, W., Ferdinand, K. C., Pavlik, V. N., Egan, B. M., Schoenthaler, A., Houston Miller, N., Hyman, D. J., & on behalf of the American Heart Association Council on Hypertension; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology (2022) · Hypertension · doi:10.1161/hyp.0000000000000203 · Cited by 349 · see citing works
Self-citationJones, D. W., Ferdinand, K. C., Taler, S. J., Johnson, H. M., Shimbo, D., Abdalla, M., Altieri, M. M., Bansal, N., Bello, N. A., Bress, A. P., et al. (2025) · JACC · doi:10.1016/j.jacc.2025.05.007 · Cited by 280 · see citing works
The role of psychological science in efforts to improve cardiovascular medication adherence.
Bosworth, H. B., Blalock, D. V., Hoyle, R. H., Czajkowski, S. M., & Voils, C. I. (2018) · American Psychologist · doi:10.1037/amp0000316 · Cited by 35 · see citing works
Outlining an Acceptance and Commitment Therapy approach to treatment non‐adherence
Graham, C. D., McCracken, L. M., Harrison, A., Walburn, J., & Weinman, J. (2022) · British Journal of Health Psychology · doi:10.1111/bjhp.12579 · Cited by 22 · see citing works
Dawson, S., Girling, C.-J., Cowap, L., & Clark-Carter, D. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013766.pub2 · Cited by 14 · see citing works
- Authors
- Choudhry, N. K., Krumme, A. A., Ercole, P. M., Girdish, C., Tong, A. Y., Khan, N. F., Brennan, T. A., Matlin, O. S., Shrank, W. H., & Franklin, J. M.
- Affiliations
- Brigham and Women's Hospital (US)
- CVS Health (United States) (US)
- Corresponding author
- Choudhry, Niteesh K.
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2017-05-01
- Volume
- 177
- Issue
- 5
- Pages
- 624
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC5470369
- OpenAlex
- W2592804631
- Cited by
- 199
- References
- 24
- Citations by year
- 2026: 7 · 2025: 24 · 2024: 11 · 2023: 18 · 2022: 21 · 2021: 30 · 2020: 21 · 2019: 24 · 2018: 26 · 2017: 17
- FWCI
- 25.07
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- medication adherence, pillbox, forgetfulness, chronic disease medications, antidepressants, medication possession ratio, pharmacy benefit management, cardiovascular drugs, pharmacy claims data
- MeSH terms
- Adolescent, Adult, Antidepressive Agents, Chronic Disease, Depressive Disorder, Female, Humans, Male, Middle Aged, United States, Logistic Models, Odds Ratio, Drug Monitoring, Reminder Systems, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
