Real-Time Electronic Adherence Monitoring is Feasible, Comparable to Unannounced Pill Counts, and Acceptable

Harvard Institute for Global Health, Cambridge, MA 02138, USA.
AIDS and Behavior (Impact Factor: 3.49). 03/2011; 16(2):375-82. DOI: 10.1007/s10461-011-9933-y
Source: PubMed


Second generation electronic medication adherence monitors provide real-time data on pill bottle opening behavior. Feasibility, validity, and acceptability, however, have not been established. Med-eMonitor is a multi-compartment adherence device with reminder and education capacity that transmits data through a telephone connection. Monthly adherence levels were measured for 52 participants over approximately 3 months using the Med-eMonitor (unadjusted and adjusted for participant confirmed dosing) and unannounced pill counts. HIV RNA was assessed before and after the 3-month period. Acceptability of Med-eMonitor was determined. Over 92% of Med-eMonitor data was transmitted daily. Unannounced pill counts significantly correlated with adjusted Med-eMonitor adherence (r = 0.29, P = 0.04). HIV RNA significantly correlated with unannounced pill counts (r = -0.34, P = 0.02), and trended toward a significant correlation with unadjusted Med-eMonitor adherence (r = -0.26; P = 0.07). Most, but not all, participants liked using the Med-eMonitor. Med-eMonitor allows for real-time adherence monitoring and potentially intervention, which may be critical for prolonging treatment success.

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Available from: Mallory O'Neill Johnson
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    • "On the patient level, electronic monitoring allows to calculate dosing intervals, taking and timing adherence; to identify specific patterns of medication use including week-end effects, drug holidays (discontinuing medication use for 24–72 h), toothbrush effect or white-coat adherence (increasing adherence several days prior to a medical appointment), and dumping (intentionally discarding medication); to identify days of under- and over-consumption; to link the timing of doses with the efficacy of the drug and with critical health incident (Riekert and Rand, 2002); to distinguish between probable and improbable drug reactions or side effects (Rudd, 1993; Riekert and Rand, 2002), and finally to give patients insight into their own dosing history. The ECMD use a microprocessor embedded in a pill bottle cap or in a storage container (Haberer et al., 2012), that records the precise date and time, every instance that the device is opened and closed. The major drawback of the bottle is that it monitors only one lead drug and thus requires one cap per medication, while the container holds up to 1-month supply of different pills in its five inner compartments. "
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    ABSTRACT: Introduction: Reliable and precise measurement of patient adherence to medications is feasible by incorporating a microcircuitry into pharmaceutical packages of various designs, such that the maneuvers needed to remove a dose of drug are detected, time-stamped, and stored. The principle is called “electronic medication event monitoring” but is currently limited to the monitoring of a single drug therapy. Aim: Our aims were introducing a new technology; a clear, self-adhesive polymer film, with printed loops of conductive wires that can be affixed to multidrug punch cards for the electronic adherence monitoring of multiple medication regimens (Polymedication Electronic Monitoring System, POEMS), and illustrating potential benefits for patient care. We present a preliminary report with one patient experience. Materials and methods: Our illustrative case was supplied with a pre-filled 7-day multiple medication punch card with unit-of-use doses for specific times of the day (six pills in the morning cavity, two pills in the evening cavity, and one pill in case of insomnia in the bedtime cavity), with the new electronic film affixed on it. Results: The intake times over 1 week were extremely skewed (median intake hours at 2:00 pm for the morning doses and at 6:40 pm for the evening doses). After an intervention aimed at optimizing the timing adherence, the morning and evening intake hours became more balanced, with 42.3% of correct dosing intervals (±3 h) for drugs with twice daily intake (vs. 0% before the intervention). Discussion: The electronic monitoring of the entire therapy revealed an intake pattern that would have remained undiscovered with any other device and allowed a personalized intervention to correct an inadequate medication intake behavior. POEMS may guide health professionals when they need to optimize a pharmacotherapy because of suspected insufficient adherence. Further, knowing the intake pattern of the entire pharmacotherapy can elucidate unreached clinical outcome, drug–drug interactions, and drug resistance. In the near future, one could imagine that medication adherence data over the entire therapy plan would be available as soon as the electronic wires are activated, so that a failure to take medication could be detected immediately and intervention could be taken if appropriate.
    Full-text · Article · Mar 2013 · Frontiers in Pharmacology
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    • "As such, habituation or a high intrusiveness can be avoided. Two pilot studies involving HIV patients on antiretroviral therapy in Uganda used real time monitoring with Wisepill [20] and the Med-eMonitor [21]. However, the real time monitoring was not combined with an intervention (such as reminding) when patients miss a dose. "
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    ABSTRACT: Poor adherence to oral antidiabetics has a negative influence on glycaemic control in type 2 diabetes patients. Real Time Medication Monitoring (RTMM) combines real time monitoring of patients' medication use with SMS reminders sent only if patients forget their medication, aiming to improve adherence. This study aimed to investigate the effect of these SMS reminders on adherence to oral antidiabetics in patients using RTMM and investigate patients' experiences with RTMM. Data were collected in a RCT involving 104 type 2 diabetes patients with suboptimal adherence to oral antidiabetics. Fifty-six patients were randomised to receive SMS reminders if they forgot their medication, 48 patients received no reminders. Primary outcome measure was adherence to oral antidiabetics registered with RTMM, measured as: (1) days without dosing; (2) missed doses; (3) doses taken within predefined standardized time windows. Patients' experiences were assessed with written questionnaires. Over the six-month study period, patients receiving SMS reminders took significantly more doses within predefined time windows than patients receiving no reminders: 50% vs. 39% within a 1-h window (p=0.003) up to 81% vs. 70% within a 4-h window (p=0.007). Reminded patients tended to miss doses less frequently than patients not reminded (15% vs. 19%, p=0.065). Days without dosing were not significantly different between the groups. The majority of patients reported positive experiences with RTMM and SMS reminders. RTMM with SMS reminders improves adherence of type 2 diabetes patients, especially the precision with which patients follow their prescribed regimen, and is well accepted by patients. Netherlands Trial Register NTR1882.
    Full-text · Article · May 2012 · International Journal of Medical Informatics
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    ABSTRACT: Many patients experience difficulties in adhering to long-term treatment. Although patients' reasons for not being adherent are diverse, one of the most commonly reported barriers is forgetfulness. Reminding patients to take their medication may provide a solution. Electronic reminders (automatically sent reminders without personal contact between the healthcare provider and patient) are now increasingly being used in the effort to improve adherence. To examine the effectiveness of interventions using electronic reminders in improving patients' adherence to chronic medication. A comprehensive literature search was conducted in PubMed, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials. Electronic searches were supplemented by manual searching of reference lists and reviews. Two reviewers independently screened all citations. Full text was obtained from selected citations and screened for final inclusion. The methodological quality of studies was assessed. Thirteen studies met the inclusion criteria. Four studies evaluated short message service (SMS) reminders, seven audiovisual reminders from electronic reminder devices (ERD), and two pager messages. Best evidence synthesis revealed evidence for the effectiveness of electronic reminders, provided by eight (four high, four low quality) studies showing significant effects on patients' adherence, seven of which measured short-term effects (follow-up period <6 months). Improved adherence was found in all but one study using SMS reminders, four studies using ERD and one pager intervention. In addition, one high quality study using an ERD found subgroup effects. This review provides evidence for the short-term effectiveness of electronic reminders, especially SMS reminders. However, long-term effects remain unclear.
    Full-text · Article · Apr 2012 · Journal of the American Medical Informatics Association
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