MERM: A device to aid patient treatment adherence

Adherence to prescribed treatment is a critical component for tuberculosis (TB) patients’ prospect of cure. MERM, short for Medication Event Reminder-Monitor, is an ongoing sub-study of PredicTB that aims to aid patient treatment adherence. Each participant in the PredictTB study receives a MERM box, a device that stores the participants’ pills and reminds them to take their medication on time.

The MERM sub-study explores health care provider and patient satisfaction with the Medication Event Reminder-Monitor (MERM) box and compares different adherence monitoring methods. The study is led by Kim Narunsky of the University of Cape Town Lung Institute in South Africa.

Dr Narunsky describes the MERM box as a cost-effective and straightforward device that, despite its humble appearance, plays a vital role in TB patients' treatment experience.

The box is a circa 25x15cm cardboard box with a built-in alarm that rings at patients’ chosen time each day to remind them to take their medication. Each time the box is opened, data is electronically captured as a record that the patient's health care provider can download by plugging in the box to a computer during one of the patient's visits at the clinic.

All PredictTB study participants receive a MERM box

Each participant enrolled in the PredicTB study is supplied with a MERM box.

Both patients and their health care providers are asked to fill in two questionnaires, one at the start and one at the end of treatment, to evaluate if their perception of the MERM box changes over time. The patient questionnaire includes questions such as:

  • Did the pill box help you remember to take your pills every day?
  • Did using the pill box increase the time it took to take your pills?
  • Would you recommend the pill box to others?

Overall, patients’ response to the MERM box has been positive so far. According to Dr Narunsky, a majority of patients have answered that they appreciate the box and that it helps them adhere to their treatment.

The questionnaire that health care providers are asked to fill out focuses on their experiences of setting up the device and accessing the MERM data.  

Data from the MERM box is compared with the traditional pill count

Patients bring their MERM box to each appointment with their clinician. The record of how many times the MERM box was opened is then compared with the results from a manual pill count.

If the MERM data does not correspond with the manual pill count, the patient and the clinician talk about what has caused the discrepancy. Dr Narunsky underlines that a discrepancy does not always mean that the patient has not taken their pill. For example, some patients take out medication for several days each time they opened the box. Still, comparing the MERM data and the pill count can help clinicians understand which patients need a bit of extra support to follow their treatment plan. 

The MERM study started together with the PredictTB project in 2017 and is scheduled to run until next year. Once all patients enrolled in the main study have completed treatment, Dr Narunsky and her colleagues will analyze all data from the MERM study and evaluate the box’s potential to improve TB patients’ adherence to treatment also outside of the context of PredictTB. 

The Medication Event Reminder-Monitor (MERM) box has a built-in alarm that rings at patients’ chosen time each day to remind them to take their medication.
The Medication Event Reminder-Monitor (MERM) box has a built-in alarm that rings at patients’ chosen time each day to remind them to take their medication.
A PredictTB participant who has just received his MERM box.
A PredictTB participant who has just received his MERM box.