Medication Dispensing Patterns Among Individuals With Serious Mental Illness Using a Remote Medication Dispensing and Adherence Monitoring Platform: Cohort Study.

backgroundMedication adherence is poor among individuals with serious mental illness (SMI). Few studies have demonstrated the effectiveness of remote medication dispensing and adherence monitoring interventions among individuals with SMI.

objectiveThis study aimed to understand medication dispensing rates for users of a remote medication dispensing and adherence monitoring device and to identify associated demographic and clinical characteristics.

methodsIn this cohort study, individuals' characteristics were measured at baseline, and dispensing records were followed from their enrollment and subsequent device installation as early as January 2019 until June 2023. Individuals were eligible to participate if they had an SMI diagnosis, were aged 18 to 64 years, were currently being prescribed psychiatric medications, and were receiving mental health services from a participating community mental health agency. Participants were recruited through a combination of self-selection and referrals from agency staff. Our intervention involved using a remote medication dispensing and adherence monitoring device to measure participants' daily medication dispensing.

resultsThe final sample consisted of 99 participants. The mean age of the participants was 49 (SD 12.08) years; 64% (n=63) of the participants identified as men and 41% (n=41) as Black or African American. The overall dispensing rate was 92.9%, with 90 (91%) individuals having dispensing rates >80%. The results of the hierarchical Bayesian logistic regression model showed that participants adhered better to evening doses than morning doses (incidence rate ratio [IRR] 1.11, 95% credible interval [CrI] 1.06-1.16). Dispensing adherence was poorer on weekends than on weekdays (IRR 0.87, 95% CrI 0.83-0.91). For every additional year of using the device, the rate of adherence increased by 1% (IRR 1.01, 95% CrI 1.00-1.01). The rate of dispensing dropped by 22% after the onset of the COVID-19 pandemic (IRR 0.78, 95% CrI 0.71-0.86), and African American participants had a 29% lower rate of dispensing than White participants (IRR 0.71, 95% CrI 0.55-0.90). The rate of dispensing did not differ by age; sex; educational attainment; or the level of sadness, emotional and behavioral dyscontrol, cognitive function, or psychotic symptoms at baseline.

conclusionsThe high adherence rate observed, regardless of baseline psychopathology levels, highlights the potential of remote medication dispensing and adherence monitoring devices to address adherence challenges in people with SMI. Observed variation in dispensing behavior by dose timing and contextual factors suggests opportunities for intervention, including aligning dosing schedules with patient routines, providing additional support during periods of disruption (eg, weekends or major life events), and tailoring strategies to address disparities across patient groups. These findings highlight the role of targeted, context-aware approaches to improve adherence in community-based SMI care. These findings support the integration of digital adherence monitoring within mental health services, especially in settings where traditional adherence support may be challenging.

trial registrationClinicalTrials.gov NCT03775044; https://clinicaltrials.gov/study/NCT03775044.