Skip to main content
SpringerLink
Log in

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

  • Published:
Journal of Clinical Psychology in Medical Settings Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  • American Psychological Association. (1992). Ethical principles of psychologists and cod of conduct. American Psychologist, 47, 1597–1611.

    Google Scholar 

  • Apter, A. J., Tor, M., & Feldman, H. I. (2001). Testing the reliability of old and new features of a new electronic monitor for metered dose inhalers. Annals of Allergy, Asthma, and Immunology, 86, 421–424.

    Google Scholar 

  • Bachmann, L. H., Stephens, J., Richey, C. M., & Hook, E.W. (1999). Measured versus self-reported compliance with doxycycline therapy for chlamydia-associated syndromes. Sexually Transmitted Diseases, 26, 272–277.

    PubMed  Google Scholar 

  • Bangsberg, D. R., Hecht, F. M., Charlebois, E. D., Zolopa, A. R., Holodniy, M., Sheiner, L., et al. (2000). Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS, 14, 357–366.

    PubMed  Google Scholar 

  • Bender, B., Wamboldt, F. S., O'Connor, S. L., Rand, C., Szefler, S., Milgrom H., et al. (2000). Measurement of children's asthma medication adherence by self report, mother report, canister weight, and Doser CT. Annals of Allergy, Asthma, and Immunology, 85, 416–421.

    Google Scholar 

  • Berg, J., Dunbar-Jacob, J., & Rohay, J. (1998). Compliance with inhaled medications: The relationship between diary and electronic monitor. Annals of Behavioral Medicine, 20, 36–38.

    PubMed  Google Scholar 

  • Blowey, D. L., Hébert, D., Arbus, G. S., Pool, R., Korus, M., & Koren, G. (1997). Compliance with cyclosporine in adolescent renal transplant recipients. Pediatric Nephrology, 11, 547–551.

    PubMed  Google Scholar 

  • Brueckner, J. W., Marshik, P., Sherman, J., & Hendeles, L. (1997). Reliability of the Medtrac MDI Chronolog. Journal of Allergy and Clinical Immunology, 100, 488–491.

    PubMed  Google Scholar 

  • Choo, P.W., Rand, C. S., Inui, T., Lee, M. L. T., Cain, E., Cordeiro-Breault, M., et al. (1999). Validation of patient reports, automated pharmacy records, and pill counts with electronic monitoring of adherence to antihypertensive therapy. Medical Care, 37, 846–857.

    PubMed  Google Scholar 

  • Cramer, J. A. (1995). Microelectronic systems for monitoring and enhancing patient compliance with medication regimens. Drugs, 49, 597–605.

    Google Scholar 

  • Fallab-Stubi, X. L., Zellweger, J. P., Sauty, A., Uldry, C., Iorillo, D., & Burnier, M. (1998). Electronic monitoring of adherence to treatment in the preventive chemotherapy of tuberculosis. International Journal of Tuberculosis and Lung Disease, 2, 525–530.

    PubMed  Google Scholar 

  • Farmer, K.C. (1999). Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clinical Therapeutics, 21, 1074–1090.

    PubMed  Google Scholar 

  • George, C. F., Peveler, R. C., & Thompson, C. (2000). Compliance with tricyclic antidepressants: The value of four different methods of assessment. British Journal of Clinical Pharmocology, 50, 166–171.

    Google Scholar 

  • Gong, H., Simmons, M. S., Clark, V. A., & Tashkin, D. P. (1988). Metered-dose inhaler usage in subjects with asthma: Comparison of Nebulizer Chronolog and daily diary recordings. Journal of Allergy and Clinical Immunology, 82, 5–10.

    PubMed  Google Scholar 

  • Johnson, B. F., Gamilton, G., Fink, J., Lucey, G., Bennet, N., & Lew, R. (2000). A design for testing interventions to improve adherence within a hypertension clinical trial. Controlled Clinical Trials, 21, 62–72.

    PubMed  Google Scholar 

  • LaGreca, A.M.(1990). Issues in adherence with pediatric regimens, Journal of Pediatric Psychology, 15, 285–308.

    Google Scholar 

  • Liu, H., Golin, C. E., Miller, L.G., Hays, R.D., Beck, K., Sanandaji, S., et al. (2001). A comparison study of multiple measures 34 Riekert and Rand of adherence to HIV protease inhibitors. Annals of Internal Medicine, 134, 1004–1006.

    PubMed  Google Scholar 

  • Matsui, D., Hermann, C., Klein, J., Berkovitch, M., Olivieri, N., & Koren, G. (1994). Critical comparison of novel and existing methods of compliance assessment during a clinical trial of an oral iron chelator. Journal of Clinical Pharmacology, 34, 944–949.

    PubMed  Google Scholar 

  • Milgrom, H., Bender, B., Ackerson, L., Bowry, P., Smity, B., & Rand, C. (1996). Noncompliance and treatment failure in children with asthma. Journal of Allergy and Clinical Immunology, 98, 1051–1057.

    PubMed  Google Scholar 

  • Paes, A.H. P., Bakker, A., & Soe-Agnie, C. J. (1998). Measurement of patient compliance. PharmacyWorld and Science, 20, 73–77.

    Google Scholar 

  • Patterson, D. L., Swindells, S., Mohr, J., Brester, M., Vergis, E. N., Squier, C., et al. (2000). Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine, 133, 21–30.

    PubMed  Google Scholar 

  • Quittner, A. L., Espelage, D. L., Ievers-Landis, C., & Drotar, D. (2000). Measuring adherence to medical treatments in childhood chronic illness: Considering multiple methods and sources of information. Journal of Clinical Psychology in Medical Settings, 7, 41–54.

    Google Scholar 

  • Rand, C. S., & Sevick, M. A. (2000). Ethics in adherence promotion and monitoring. Controlled Clinical Trials, 21, 241S–247S.

    PubMed  Google Scholar 

  • Rand, C. S., & Weeks, K. (1998). Measuring adherence with medication regimens in clinical care research. In S. A. Shumaker, E. Schron, J. Ockene, & W. McBee (Eds.), The handbook of health behavior change (2nd ed., pp. 114–132). New York: Springer.

    Google Scholar 

  • Rand, C. S., & Wise, R. A. (1994). Measuring adherence to asthma mediation regimens. American Journal of Respiratory and Critical Care Medicine, 149, S69–S76.

    PubMed  Google Scholar 

  • Rand, C. S., Wise, R. A., Nides, M., Simmons, M. S., Bleecker, E. R., Kusek, J.W., et al. (1992). Metered-dose inhaler adherence in a clinical trial. American Review of Respiratory Disease, 146, 1559–1564.

    PubMed  Google Scholar 

  • Rapoff, M.A. (1999). Adherence to pediatric medical regimens. New York, NY: Kluwer Academic/Plenum Publishers.

    Google Scholar 

  • Rivers, P. H., Ardagh-Walter, N., & Wright E. C. (1998). Measurement of anticonvulsant adherence behavior in the community using a medication events monitoring system (MEMS). Health Care Analysis, 6, 308–316.

    PubMed  Google Scholar 

  • Rudd, P. (1993). The measurement of compliance: Medication taking. In M.A. Krasnegor, L. Epstein, S. B. Johnson, & S. J. Yaffe (Eds.), Developmental aspects of health compliance behavior (pp. 185–213). Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • Schwed, A., Fallab, C. L., Burnier, M., Waeber, B., Kappenberger, L., Burnand, B., et al. (1999). Electronic monitoring of compliance to lipid-lowering therapy in clinical practice. Journal of Clinical Pharmacology, 39, 402–409.

    PubMed  Google Scholar 

  • Simmons, M. S., Nides, M. A., Kleerup, E., Chapman, K. R., Milgrom, H., Rand, C. S., et al. (1998). Validation of the Doser, a new device for monitoring meter-dose inhaler use. Journal of Allergy and Clinical Immunology, 102, 409–413.

    PubMed  Google Scholar 

  • Simmons, M. S., Nides, M. A., Rand, C. S., Wise, R. A., & Tashkin, D. P. (1996). Trends in compliance with bronchodilators inhaler use between follow-up visits in a clinical trial. Chest, 109, 963–968.

    PubMed  Google Scholar 

  • Steiner, J. F., & Proshazka, A. V. (1997). The assessment of refill compliance using pharmacy records: Methods, Validity, and applications. Journal of Clinical Epidemiology, 50, 105–116.

    PubMed  Google Scholar 

  • Straka, R. J., Fish, J. T., Benson, S. R., & Suh, J. T. (1997). Patient self-reporting of compliance does not correspond with electronic monitoring: An evaluation using isosorbide dinitrate as a model drug. Pharmacotherapy, 17, 126–132.

    PubMed  Google Scholar 

  • Tashkin, D. P., Rand, C., Nides, M., Simmons, M., Wise, R., Coulson, A. H., et al. (1991). A Nebulizer Chronolog to monitor compliance with inhaler use. The American Journal of Medicine, 91, 4A-33S–4A-36S.

    Google Scholar 

  • Urquhart, J. (1997). The electronic medication event monitor: Lessons for pharmacotherapy. Clinical Pharmacokinet, 32, 345–356.

    Google Scholar 

  • Vijens, B., & Goetghebeur, E. (1997). Comparing compliance patterns between randomized treatments. Controlled Clinical Trials, 18, 187–203.

    PubMed  Google Scholar 

  • Wamboldt, F. S., Bender, B. G., O'Connor, S. L., Gavin, L. A., Wamboldt, M. Z., Milgrom, H., et al. (1999). Reliability of the model MC-311 MDI Chronolog. Journal of Allergy and Clinical Immunology, 104, 53–57.

    PubMed  Google Scholar 

  • Weeks, K., Rand, C., & Wise, R. (1997). Guidelines for interpreting metered dose inhaler (MDI) adherence with a thermistoractuatedMDIchronolog. American Journal of Respiratory and Critical Care Medine, 155(4), A310.

    Google Scholar 

  • Weeks, K., Schweiger, D., Wise, R., & Rand, C. (1998). Accuracy of theMDIlog—A new electronic metered-dose inhaler monitor. Annalsof Behavioral Medicine, 20 (Suppl.), S223.

    Google Scholar 

  • Williams, D. M., Wessell, A., & Brock, T. P. (1999). The Doser external counting device. Chest, 116, 1499.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

    Kristin A. Riekert & Cynthia S. Rand

Authors
  1. Kristin A. Riekert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cynthia S. Rand
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kristin A. Riekert.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Riekert, K.A., Rand, C.S. Electronic Monitoring of Medication Adherence: When Is High-Tech Best?. Journal of Clinical Psychology in Medical Settings 9, 25–34 (2002). https://doi.org/10.1023/A:1014131928789

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1014131928789

Search

Navigation