Effects of Use of a Connected Pillbox On Medication Adherence

Randomized Control Trial Patients in the research treatment group receive pre-filled, 3x7
disposable trays that separate their medication by dose and time (e.g. morning, afternoon,
evening). These pre-filled trays are inserted into a connected, weekly pillbox that detects
when pills are removed from its wells. Using this information, TowerView Health system is
able to send automated text messages or phone reminders to patients to take forgotten or
ignored medication doses. Medication adherence data from deployed pillboxes populates a
software platform, which a research coordinator can access.

Patients who miss 3 consecutive doses or 5 doses out of 12 over a 4-day period trigger an
alert for the study research coordinator who can contact the patient via phone call. The
research coordinator follows a scripted motivational interview in his or her outreach to
determine the etiology of non-adherence. Patients reporting worrisome symptoms will be
instructed to contact their provider directly and/or go to the emergency room for immediate
attention. The investigator acknowledges that the current study actually involves multiple
interventions: 1. The pre-filled medication trays are provided by a pharmacist, which
overcomes medication access issues as well as the inconvenience of manually organizing
medications. 2. The electronic pillbox, which monitors adherence that triggers text message
or phone reminders in instances where patients forget or ignore medication doses 3. Research
coordinator alerts, which trigger outreach events that employ a motivational interview in
order to improve patient adherence.

Inclusion Criteria:• Insurance and pharmacy coverage with Independence Blue Cross (IBC); 18
years or older; Current diagnosis of Type II Diabetes Mellitus, Hypertension or
Hyperlipidemia and taking 5 or more medications; Less than 80% medication adherence; Able
to communicate in English; Willing to give informed consent, receive recruitment
(invitation)letter from IBC

Exclusion Criteria: Known alcohol or illicit drug abuse; Significant cognitive impairment
at baseline as defined by the Animal Naming Screening Tool; Residence in a care facility
that provides medication on schedule; Unwilling to use TowerView Health's connected pillbox
and accompanying medication trays; Any active medical or psychiatric diagnosis that, based
on the clinical assessment of the research team, would prevent the study participant from
completing the trial such as: markedly shortened life expectancy (e.g. diagnosis of
metastatic cancer, end stage renal disease on dialysis, New York Heart Association (NYHA)
Class III or IV heart failure, active psychosis or suicidal ideation, etc.) or
dexterity/motor impairments (e.g. severe arthritis, neuromuscular disorders, etc); and Lack
a mobile or land line phone.