Electronic monitoring of adherence in clinical care: Ethical and practical considerations.

Abstract

Objective: Adherence to prescribed medical regimens is a key behavior for managing disease burden and progression. Despite the importance of understanding a child's adherence, many evidence-based assessment strategies have not been implemented into subspecialty clinical practice. The aim of this article was to highlight the potential ethical and regulatory challenges of using electronic monitoring (EM) of adherence in clinical care and offer practical solutions. Methods: Relevant ethical and legal standards were researched and summarized as applicable to EM of adherence. Results: Issues related to Human Relations, Privacy and Confidentiality, Record Keeping, and Assessment all apply to EM of adherence. Conclusions: Clinicians should be mindful and seek to proactively address issues related to informed consent, autonomy, privacy, and equity before starting an EM program of adherence. Multidisciplinary teams should thoroughly consider the ethical and legal aspects of implementing this form of adherence assessment into clinical practice. Implications for Impact StatementThis topical review is the first to describe the practical implications of utilizing electronic monitoring of adherence in a clinical care setting with a multidisciplinary medical team. This is an important reference for any pediatric psychologist or practitioner who wants to be fully informed about the potential ethical and legal ramifications of using this technology with youth.

Introduction to the special issue on pediatric adherence and self-management: Topical reviews and clinical applications of evidence-based assessment and intervention.

“…Electronic monitoring is the gold-standard of measuring adherence to oral medications (Riekert & Rand, 2002). As highlighted in Rich et al (2022), new developments in technology allow for electronic monitoring of inhaled and injectable medications as well. However, electronic monitoring has not been widely used or discussed for use in pediatric clinical care, and there are several ethical issues that arise when considering utilizing these methods outside of a research context.…”

“…However, electronic monitoring has not been widely used or discussed for use in pediatric clinical care, and there are several ethical issues that arise when considering utilizing these methods outside of a research context. Rich et al (2022) review these various ethical dilemmas, and present a compelling case study of an adolescent with kidney disease. Specifically, concerns with informed consent, autonomy, privacy, and equity are discussed, and providers are encouraged to carefully consider implementing electronic monitoring of adherence in pediatric clinical care and to have a thorough discussion with both the patient and their caregiver regarding the ethical implications of this evidence-based method of measuring medication adherence.…”