Chronic diseases, including diabetes, hypertension, asthma, HIV-AIDS, epilepsy, and tuberculosis, necessitate rigorous adherence to medication to avert disease progression, manage symptoms, and decrease mortality rates. Adherence is frequently undermined by factors including patient behavior, caregiver support, elevated medical costs, and insufficient healthcare infrastructure. We propose AdCare-VLM, a specialized LLaVA-based multimodal large vision language model (LVLM) by introducing a unified visual latent space with pre-alignment to facilitate visual question answering (VQA) concerning medication adherence through patient videos. We employ a private dataset comprising 806 custom-annotated tuberculosis (TB) medication monitoring videos, which have been labeled by clinical experts, to fine-tune the model for adherence pattern detection. We present LLM-TB-VQA, a detailed medical adherence VQA dataset that encompasses positive, negative, and ambiguous adherence cases. Our method identifies correlations between visual features, such as the clear visibility of the patient's face, medication, water intake, and the act of ingestion, and their associated medical concepts in captions. This facilitates the integration of aligned visual-linguistic representations and improves multimodal interactions. Experimental results indicate that our method surpasses parameter-efficient fine-tuning (PEFT) enabled VLM models, such as LLaVA-V1.5 and Chat-UniVi, with absolute improvements ranging from 3.1% to 3.54% across pre-trained, regular, and low-rank adaptation (LoRA) configurations. Comprehensive ablation studies and attention map visualizations substantiate our approach, enhancing interpretability.

Non-adherence to medications is a critical concern since nearly half of patients with chronic illnesses do not follow their prescribed medication regimens, leading to increased mortality, costs, and preventable human distress. Amongst stage 0-3 breast cancer survivors, adherence to long-term adjuvant endocrine therapy (i.e., Tamoxifen and aromatase inhibitors) is associated with a significant increase in recurrence-free survival. This work aims to develop multi-scale models of medication adherence to understand the significance of different factors influencing adherence across varying time frames. We introduce a computational framework guided by Social Cognitive Theory for multi-scale (daily and weekly) modeling of longitudinal medication adherence. Our models employ both dynamic medication-taking patterns in the recent past (dynamic factors) as well as less frequently changing factors (static factors) for adherence prediction. Additionally, we assess the significance of various factors in influencing adherence behavior across different time scales. Our models outperform traditional machine learning counterparts in both daily and weekly tasks in terms of both accuracy and specificity. Daily models achieved an accuracy of 87.25%, and weekly models, an accuracy of 76.04%. Notably, dynamic past medication-taking patterns prove most valuable for predicting daily adherence, while a combination of dynamic and static factors is significant for macro-level weekly adherence patterns.

Asthma is a chronic respiratory condition that affects millions of people worldwide. While this condition can be managed by administering controller medications through handheld inhalers, clinical studies have shown low adherence to the correct inhaler usage technique. Consequently, many patients may not receive the full benefit of their medication. Automated classification of inhaler sounds has recently been studied to assess medication adherence. However, the existing classification models were typically trained using data from specific inhaler types, and their ability to generalize to sounds from different inhalers remains unexplored. In this study, we adapted the wav2vec 2.0 self-supervised learning model for inhaler sound classification by pre-training and fine-tuning this model on inhaler sounds. The proposed model shows a balanced accuracy of 98% on a dataset collected using a dry powder inhaler and smartwatch device. The results also demonstrate that re-finetuning this model on minimal data from a target inhaler is a promising approach to adapting a generic inhaler sound classification model to a different inhaler device and audio capture hardware. This is the first study in the field to demonstrate the potential of smartwatches as assistive technologies for the personalized monitoring of inhaler adherence using machine learning models.

This study reveals the important role of prevention care and medication adherence in reducing hospitalizations. By using a structured dataset of 1,171 patients, four machine learning models Logistic Regression, Gradient Boosting, Random Forest, and Artificial Neural Networks are applied to predict five-year hospitalization risk, with the Gradient Boosting model achieving the highest accuracy of 81.2%. The result demonstrated that patients with high medication adherence and consistent preventive care can reduce 38.3% and 37.7% in hospitalization risk. The finding also suggests that targeted preventive care can have positive Return on Investment (ROI), and therefore ML models can effectively direct personalized interventions and contribute to long-term medical savings.

Adherence to prescribed treatments is crucial for individuals with chronic conditions to avoid costly or adverse health outcomes. For certain patient groups, intensive lifestyle interventions are vital for enhancing medication adherence. Accurate forecasting of treatment adherence can open pathways to developing an on-demand intervention tool, enabling timely and personalized support. With the increasing popularity of smartphones and wearables, it is now easier than ever to develop and deploy smart activity monitoring systems. However, effective forecasting systems for treatment adherence based on wearable sensors are still not widely available. We close this gap by proposing Adherence Forecasting and Intervention with Machine Intelligence (AIMI). AIMI is a knowledge-guided adherence forecasting system that leverages smartphone sensors and previous medication history to estimate the likelihood of forgetting to take a prescribed medication. A user study was conducted with 27 participants who took daily medications to manage their cardiovascular diseases. We designed and developed CNN and LSTM-based forecasting models with various combinations of input features and found that LSTM models can forecast medication adherence with an accuracy of 0.932 and an F-1 score of 0.936. Moreover, through a series of ablation studies involving convolutional and recurrent neural network architectures, we demonstrate that leveraging known knowledge about future and personalized training enhances the accuracy of medication adherence forecasting. Code available: https://github.com/ab9mamun/AIMI.

Medication adherence is critical for the recovery of adolescents and young adults (AYAs) who have undergone hematopoietic cell transplantation (HCT). However, maintaining adherence is challenging for AYAs after hospital discharge, who experience both individual (e.g. physical and emotional symptoms) and interpersonal barriers (e.g., relational difficulties with their care partner, who is often involved in medication management). To optimize the effectiveness of a three-component digital intervention targeting both members of the dyad as well as their relationship, we propose a novel Multi-Agent Reinforcement Learning (MARL) approach to personalize the delivery of interventions. By incorporating the domain knowledge, the MARL framework, where each agent is responsible for the delivery of one intervention component, allows for faster learning compared with a flattened agent. Evaluation using a dyadic simulator environment, based on real clinical data, shows a significant improvement in medication adherence (approximately 3%) compared to purely random intervention delivery. The effectiveness of this approach will be further evaluated in an upcoming trial.

During the middle of the 20th century, scientists and social theorists began to fear the problem of overpopulation, predicting a period of mass starvation. Famously, Stanford's Paul Ehrlich, in his 1968 book, "The Population Bomb" predicted "the battle to feed all of humanity is over...hundreds of millions of people will starve to death in spite of any crash programs embarked upon now." At the time, his pessimistic thinking was not isolated. Simultaneously, Norman Borlaug became a pioneer in wheat production with his work in genetics powering new ways to grow crops. His "Green Revolution" for which he received the 1970 Nobel Peace Prize, is credited with saving over a billion lives.

It has been estimated that 1.7 million people die from Tuberculosis (TB), and more than 10.4 million new cases are reported every year worldwide. The global'End TB' strategy aims to eliminate the disease by 2030. However, realizing this goal would be challenging if there were to be a gap in treatment adherence to prescribed medication. In the context of TB and HIV coinfection, non-adherence to the medication has been associated with the incidence of drug resistance, prolonged infection, unsuccessful treatments, and death. Africa experiences a severe shortage of healthcare workers, making delivering proper healthcare difficult.

Poor medication adherence presents serious economic and health problems including compromised treatment effectiveness, medical complications, and loss of billions of dollars in wasted medicine or procedures. Though various interventions have been proposed to address this problem, there is an urgent need to leverage light, smart, and minimally obtrusive technology such as smartwatches to develop user tools to improve medication use and adherence. In this study, we conducted several experiments on medication-taking activities, developed a smartwatch android application to collect the accelerometer hand gesture data from the smartwatch, and conveyed the data collected to a central cloud database. We developed neural networks, then trained the networks on the sensor data to recognize medication and non-medication gestures. With the proposed machine learning algorithm approach, this study was able to achieve average accuracy scores of 97% on the protocol-guided gesture data, and 95% on natural gesture data.

According to Søren Smed Østergaard, Vice President, Digital Health of Novo Nordisk, the most significant innovations in the diabetes space centered around hardware, artificial intelligence (AI) and data. He believes that having access to more accurate data on individual behavior and medication usage could positively impact people living with diabetes. "We know there is a huge discrepancy between how people should use medication and how they're using it," said Østergaard. "In 2003, the World Health Organisation (WHO) said improving medication adherence will have a more significant impact on the population's health than improvements to specific medical treatments. "Healthcare data today is often incomplete and too sparse to use for effective decision-making; we need to solve that first, but with this comes a plethora of ethical implications," said Østergaard. "People must have confidence that their data is being kept secure and used responsibly. Data sharing – creating a complete picture using data from different parties and devices – has the potential to revolutionize healthcare and outcomes, but robust data privacy policies must underpin it.