Electronic Monitoring of Medication Adherence: When Is High-Tech Best?

The accurate measurement of medication adherence is challenging, particularly in pediatrics. Electronic monitoring has been proposed as a possible “gold standard” for medication adherence measurement. Electronic monitoring permits the evaluation of patterns of medication use and dose-response relationship and may be a useful part of adherence promotion interventions. The use of these devices, however, is not without costs and cautions including, expense, malfunctioning, and interference with existing adherence routines. This review examines the costs and benefits of using electronic monitoring of adherence as well as the reliability and validity of electronic monitoring in general and, where possible, for specific devices (i.e., MEMS, MDIlog, and Doser). Finally, we provide recommendations for quality control protocols to minimize many of the problems encountered when using such devices. Ultimately, the choice of adherence measurement strategy should be based on the goal of the study and the resources available.

[1]  G. Koren,et al.  Compliance with cyclosporine in adolescent renal transplant recipients , 1997, Pediatric Nephrology.

[2]  C. Rand,et al.  Validation of patient reports, automated pharmacy records, and pill counts with electronic monitoring of adherence to antihypertensive therapy. , 1999, Medical care.

[3]  C. Rand,et al.  Noncompliance and treatment failure in children with asthma. , 1996, The Journal of allergy and clinical immunology.

[4]  C. Rand,et al.  Measuring adherence to asthma medication regimens. , 1994, American journal of respiratory and critical care medicine.

[5]  A V Prochazka,et al.  The assessment of refill compliance using pharmacy records: methods, validity, and applications. , 1997, Journal of clinical epidemiology.

[6]  M. Burnier,et al.  Electronic Monitoring of Compliance to Lipid‐Lowering Therapy in Clinical Practice , 1999, Journal of clinical pharmacology.

[7]  A. M. Greca.  Social Consequences of Pediatric Conditions: Fertile Area for Future Investigation and Intervention? , 1990 .

[8]  A. M. Greca.  Issues in Adherence With Pediatric Regimens , 1990 .

[9]  L. Hendeles,et al.  Reliability of the Medtrac MDI Chronolog. , 1997, Journal of Allergy and Clinical Immunology.

[10]  R. Lew,et al.  A design for testing interventions to improve adherence within a hypertension clinical trial. , 2000, Controlled clinical trials.

[11]  C. Rand,et al.  Trends in compliance with bronchodilator inhaler use between follow-up visits in a clinical trial. , 1996, Chest.

[12]  R C Peveler,et al.  Compliance with tricyclic antidepressants: the value of four different methods of assessment. , 2000, British journal of clinical pharmacology.

[13]  D. Drotar,et al.  Measuring Adherence to Medical Treatments in Childhood Chronic Illness: Considering Multiple Methods and Sources of Information , 2000, Journal of Clinical Psychology in Medical Settings.

[14]  Susan Swindells,et al.  Adherence to Protease Inhibitor Therapy and Outcomes in Patients with HIV Infection , 2000, Annals of Internal Medicine.

[15]  A. Paes,et al.  Measurement of patient compliance. , 1998, Pharmacy World and Science.

[16]  E. Hook,et al.  Measured versus self-reported compliance with doxycycline therapy for chlamydia-associated syndromes: high therapeutic success rates despite poor compliance. , 1999, Sexually transmitted diseases.

[17]  B Vrijens,et al.  Comparing compliance patterns between randomized treatments. , 1997, Controlled clinical trials.

[18]  F. Hecht,et al.  Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population , 2000, AIDS.

[19]  C. Rand,et al.  Validation of the Doser, a new device for monitoring metered-dose inhaler use. , 1998, The Journal of allergy and clinical immunology.

[20]  R. Straka,et al.  Patient Self‐Reporting of Compliance Does Not Correspond with Electronic Monitoring: An Evaluation Using Isosorbide Dinitrate as a Model Drug , 1997, Pharmacotherapy.

[21]  Robert A. Wise,et al.  Metered-dose inhaler adherence in a clinical trial. , 1992, The American review of respiratory disease.

[22]  M. Rapoff,et al.  Adherence to Pediatric Medical Regimens , 1999, Issues in Clinical Child Psychology.

[23]  M. Burnier,et al.  Electronic monitoring of adherence to treatment in the preventive chemotherapy of tuberculosis. , 1998, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[24]  J. Rohay,et al.  Compliance with inhaled medications: The relationship between diary and electronic monitor , 1998, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[25]  M. Sevick,et al.  Ethics in adherence promotion and monitoring. , 2000, Controlled clinical trials.

[26]  K. Farmer,et al.  Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. , 1999, Clinical therapeutics.

[27]  J Urquhart,et al.  The Electronic Medication Event Monitor , 1997, Clinical pharmacokinetics.

[28]  H. Feldman,et al.  Testing the reliability of old and new features of a new electronic monitor for metered dose inhalers. , 2001, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[29]  R. Hays,et al.  A Comparison Study of Multiple Measures of Adherence to HIV Protease Inhibitors , 2001, Annals of Internal Medicine.

[30]  G Koren,et al.  Critical Comparison of Novel and Existing Methods of Compliance Assessment During a Clinical Trial of an Oral Iron Chelator , 1994, Journal of clinical pharmacology.

[31]  Barbara Turner,et al.  Improving on a Coin Toss To Predict Patient Adherence to Medications , 2001, Annals of Internal Medicine.

[32]  V. Clark,et al.  Metered-dose inhaler usage in subjects with asthma: comparison of Nebulizer Chronolog and daily diary recordings. , 1988, The Journal of allergy and clinical immunology.

[33]  C. Rand,et al.  A nebulizer chronolog to monitor compliance with inhaler use. , 1991, The American journal of medicine.

[34]  C. Rand,et al.  Reliability of the model MC-311 MDI chronolog. , 1999, The Journal of allergy and clinical immunology.

[35]  C. Rand,et al.  Measurement of children's asthma medication adherence by self report, mother report, canister weight, and Doser CT. , 2000, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.