Challenges in implementing a feasibility study of RFID-enabled blister packs for real-time adherence monitoring in outpatient schizophrenia care

Background: Adherence to medication is particularly problematic for patients with mental health problems. Prior attempts to address non-adherence in treating mental illness use tools of retrospective surveillance rather than real-time intervention. Technology, such as RFID-enabled “smart” blister packs, enables real-time monitoring which provides a finer grain of detail than retrospective pharmacy or self-report data and can be used to support and empower patients to maintain the stable routines which they themselves have elected by providing immediate access to critical data which caregivers can act upon. Using this technology, patients can feel more connected to their physicians and in better control of their therapeutic routines, improve medication adherence and patient self-efficacy while reducing relapse and its associated costs. Objectives: To identify the challenges in conducting a pilot study using RFID-enabled blister packs for real-time adherence monitoring. Methods: In the attempted study, patients in an intervention group would remove their pills from “smart” packaging, which stores a date and time stamp in the blister pack recording the event. A cellular reader with daily monitoring allows a healthcare provider to intervene each time a critical threshold of non-adherence is crossed. Results: Preliminary data is not yet available. We anticipated encountering challenges in using a health information technology intervention for real-time monitoring among a behavioral health population; however we faced significant challenges in just getting the pilot off the ground. Unlike clinical drug trials, with tightly controlled environments where drugs are provided directly by the manufacturer, it is significantly more challenging to work with packaging technology when the medication is being purchases independently. Investigators trying to alter the packaging of medication purchased through a retail pharmacy face significant challenges.