Background: Adverse drug events (ADEs) are common during transitions from the hospital to the ambulatory setting, with approximately 20% of patients experiencing an ADE within 30 days of discharge. ADEs are often due to patient misunderstanding of the prescribed medication regimen or non-adherence to the regimen.  New approaches are needed to address this problem.

Purpose: To implement a “smart” pillbox intervention for patients admitted to the medical service of a large, urban hospital who will be discharged home and are on 5 or more chronic medications, and to evaluate the effects of the intervention on post-discharge medication discrepancies, medication adherence, and chronic disease management. 


The intervention consists of a “smart” pillbox with weekly blister pack medication trays that are pre-filled by a pharmacist. The pillbox chimes and the appropriate medication well lights up when it is time for the patient to take his/her medications, with further reminders if the patient does not remove all medications from the well.  The pillbox can also send alerts to patients or caregivers by phone, email, or text, and it generates adherence reports accessible by patients/caregivers, and providers by way of a link within the electronic health record (EHR). The adherence report shows adherence patterns by time of day and day of the week as well as adherence trends over time (Figure 1).  When adherence is less than 80% for three consecutive days, outreach from a pharmacist case manager is triggered.

The smart pillbox has been pilot tested on several patients, during which several lessons were learned about providing this intervention during the hospital to home transition. These include: 1) engaging the medical team to complete discharge medication reconciliation in advance if possible; 2) having families bring in pill bottles from home or covering the costs of medications that have been recently filled and need to be dispensed at discharge; 3) leveraging the EHR to provide the discharge medication regimen to the smart pillbox’s software application; 5) using the hospital’s ambulatory pharmacy and their “meds to beds” program for the initial supply of medications; 6) comparing the dispensing pharmacy’s list to the medication regimen in the EHR prior to shipping each new supply of medications; and 7) engaging primary care providers in this process.

Conclusions: A “smart” pillbox intervention has the potential to improve medication safety during transitions of care. This study will advance the field by quantifying the benefits of this type of intervention in the transitions setting, where it has not been previously evaluated and where there is demonstrable need for improvement.