Does Electronic Monitoring Influence Adherence to Medication? Randomized Controlled Trial of Measurement Reactivity

Abstract

BackgroundElectronic monitoring is recommended for accurate measurement of medication adherence but a possible limitation is that it may influence adherence.PurposeTo test the reactive effect of electronic monitoring in a randomized controlled trial.MethodsA total of 226 adults with type 2 diabetes and HbA1c ≥58 mmol/mol were randomized to receiving their main oral glucose lowering medication in electronic containers or standard packaging. The primary outcomes were self-reported adherence measured with the MARS (Medication Adherence Report Scale; range 5–25) and HbA1c at 8 weeks.ResultsNon-significantly higher adherence and lower HbA1c were observed in the electronic container group (differences in means, adjusting for baseline value: MARS, 0.4 [95 % CI −0.1 to 0.8, p = 0.11]; HbA1c (mmol/mol), −1.02 [−2.73 to 0.71, p = 0.25]).ConclusionsElectronic containers may lead to a small increase in adherence but this potential limitation is outweighed by their advantages. Our findings support electronic monitoring as the method of choice in research on medication adherence. (Trial registration Current Controlled Trials ISRCT N30522359)

Determinants of methotrexate adherence in rheumatoid arthritis patients

“…A weaker correlation was found between the MARS-5 and the electronic monitoring which is consistent with the results of an earlier study [2]. Finally, the sum score of the CQR did not show a significant association with the results of the electronic monitoring.…”

“…The intake behavior is quantified by the use of a medication container of which the cap includes a chip that registers the moment of opening [2]. A patient was considered fully adherent if over a period of 1 week the MEMS ® container was opened once or more in accordance with the prescription.…”

“…Assessing adherence and identifying reasons for (non-) adherence is therefore important from a clinical perspective. The way medication adherence is measured may however be responsible for diversity in results [2]. Self-reported adherence mostly results in higher adherence rates than electronic monitoring, which was only used in two studies in RA patients [3,4].…”

Electronically monitored dosing histories can be used to develop a medication-taking habit and manage patient adherence

“…One could expect that EM alone, without feedback, can already improve adherence due to the patients' knowing that they are being monitored. However, this view is contradicted by a recent trial showing that EM alone had no statistically significant increase in adherence when compared to standard packaging [32], supporting the importance of the feedback component.…”

The INCATM (Inhaler Compliance AssessmentTM): A comparison with established measures of adherence

“…However, this specific focus enabled a comprehensive investigation of adherence to a commonly prescribed COPD treatment. It could be argued that participants may have changed their inhaler use as a consequence of study enrolment, however previous examinations of a potential Hawthorne Effect (Williams, Amico, Bova, & Womack, 2013) in adherence studies have shown this not to be the case (Sutton et al, 2014).…”