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Electronic Monitoring in Medication Adherence Measurement

Implications for Dermatology

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Abstract

Poor adherence with prescribed therapy often results in decreased efficacy, annoying for patient both and physician. Negative health improvement adds extensive costs to the healthcare system. Thus, physicians need to carefully examine medication adherence before investigating possible pharmacologic reasons for drug failure or initiating alternative treatments and special diagnostic tests. Documenting medication adherence can also help with the development of new drugs and establishing optimized treatment regimens.

Reliable distinction between non-adherence and nonresponse is a new issue for medicine, the pharmaceutical industry and its regulators. Investigation of adherence patterns has been established on evidence-based clinical and biostatistical research agendas.

Originally, the term ‘compliance’ was used to describe how a patient adheres to a recommended therapy plan. Subsequently, ‘compliance’ has been changed to the more appropriate term ‘adherence’. Several approaches to studying the relationship between medication adherence and medical outcome exist. This article provides an overview on medical adherence and methods of measuring adherence, especially electronic monitoring.

Traditional methods of adherence assessment (patient interview, diaries, questionnaires, pill counts, prescription refill surveys) often do not deliver reliable data. Thus, researchers have tried to approach adherence by measuring serum drug concentrations or other biologic or chemical markers to gain more objective data. However, the state of the art for analyzing adherence is the use of electronic monitoring devices, electronic event monitors. Such devices not only provide more reliable data but also more detailed data about actual patient adherence, such as dose frequency, dose time, dose interval and dose timing — details that traditional methods do not show. Electronic monitoring shows that poor adherence, especially dosage omission or changing intervals, is more prevalent than previously recognized. The detailed adherence patterns provided by electronic monitoring show the need for a new kind of drugs. These drugs should provide good therapeutic coverage despite dosage omission and are therefore called ‘forgiving pharmaceuticals’.

Adherence and medical outcome have been extensively studied in patients with psychiatric disorders, hypertension and other cardiovascular disorders and most recently in patients receiving HIV/AIDS therapy. But non-adherence can be found in any medical field. Regarding the lack of equivalent studies on adherence and therapeutic efficacy in treating skin diseases, this topic should be looked at more closely in dermatology. Recalcitrant atopic dermatitis, psoriasis, tinea pedis and acne would be ideal study areas.

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References

  1. Cramer J.A. Relationship between medication compliance and medical outcomes. Am J Health Syst Pharm 1995; 52 Suppl. 3: S27–S29

    PubMed  CAS  Google Scholar 

  2. URL:http://www.aardexus.com [Accessed 2000 Aug 8]

  3. Cramer J.A. Microelectonic systems for monitoring and enhancing patient compliance with medication regimens. Drugs 1995; 59 (3): 321–327

    Article  Google Scholar 

  4. Urquhart J. Correlates of variable patient compliance in drug trials: relevance in the new health care environment. In: Testa B., Meyer U.A., editors. Advances in drug research. London: Academic Press 1995: 238–257

    Google Scholar 

  5. Cramer J., Vachon L. Desforges C., Sussman N.M. Dose frequency and dose interval compliance with multiple antiepileptic medications during a controlled clinical trial. Epilepsia 1995; 36: 1111–1117

    Article  PubMed  CAS  Google Scholar 

  6. McKenney J.M., Munroe W.P., Wright J.T. Impact of an electronic medication compliance aid on long-term blood pressure control. J Clin Pharmacol 1992; 32: 277–283

    PubMed  CAS  Google Scholar 

  7. Urquhart J. Can drug delivery systems deliver value in the new pharmaceutical marketplace? Br J Clin Pharmacol 1997; 44: 413–419

    Article  PubMed  CAS  Google Scholar 

  8. Nides M.A., Tashkin D.P., Simmons M.S., et al. Improving inhaler adherence in a clinical trial through the use of the Nebulizer Chronolog. Chest 1993; 104: 501–507

    Article  PubMed  CAS  Google Scholar 

  9. Feldman H.I., Hackett M., Bilker W. Potential utility of electronic drug compliance monitoring in measures of adverse outcomes associated with immunosuppressive agents. Pharmacoepidemiol Drug Safet 1999; 8: 1–14

    Article  CAS  Google Scholar 

  10. Nides M.A., Tashkin D.P., Simmons M.S., et al. Patient noncompliance: a major cause of late graft failure in cyclosporine-treated renal patients. Transplant Proc 1988; 21: 833–834

    Google Scholar 

  11. Kass M.A., Meltzer D., Gordon M., et al. Compliance with topical Pilocarpine treatment. Am J Ophthalmol 1986; 101: 515–523

    PubMed  CAS  Google Scholar 

  12. Paterson D.L., Swindells S., Mohr J., et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med 2000; 133 (1): 21–30

    PubMed  CAS  Google Scholar 

  13. Anastasio G.D., Little J.M., Robinson M.D., et al. Impact of compliance and side effects on the clinical outcome of patients treated with oral erythromycin. Pharmacotherapy 1994; 14 (2): 229–234

    PubMed  CAS  Google Scholar 

  14. Cramer J.A., Mattson R.H., Prevey M.L., et al. How often is medication taken as prescribed? A novel assessment technique. JAMA 1989; 261: 3273–3277

    Article  PubMed  CAS  Google Scholar 

  15. Piacquadio D., Kligman A. The critical role of the vehicle to therapeutic efficacy and patient compliance. J Am Acad Dermatol 1998 Aug 2–3; 39: S67–S73

    Article  PubMed  CAS  Google Scholar 

  16. Kastrissios H., Blaschke T.F. Medication compliance as a feature in drug development. Annu Rev Pharmacol Toxicol 1997; 37: 451–475

    Article  PubMed  CAS  Google Scholar 

  17. Meredith P.A. Therapeutic implications of drug ‘holidays’. European Heart Journal 1996; 17 Suppl. A: 21–24

    Article  PubMed  Google Scholar 

  18. Murphy J., Coster G. Issues in patient compliance. Drugs 1997; 54 (6): 707

    Article  Google Scholar 

  19. Sackett D.L. Introduction. In: Sackett D.L., Hanes R.B., editors. Compliance with therapeutic regimens. Baltimore: Johns Hopkins University Press, 1976: 1–6

    Google Scholar 

  20. Cramer J.A., Mattson R.H. Monitoring compliance with antiepileptic drug therapy. In: Cramer J.A., Spilker B., editors. Patient compliance in medical practice and clinical trials. New York: Raven 1991: 123–138

    Google Scholar 

  21. Cramer J.A. Quality of life and compliance. In: Trimble M.R., Dodson W.E., editors. Epilepsy and quality of life. New York: Raven 1994: 49–63

    Google Scholar 

  22. Rudd P., Ahmed S., Zachary V., et al. Improved compliance measures: applications in an ambulatory hypertensive drug trial. Clin Pharmacol Ther 1990; 48: 676–685

    Article  PubMed  CAS  Google Scholar 

  23. Guerro D., Rudd P., Bryant-Kosling C., et al. Antihypertensive medication-taking. Investigation of a simple regimen. Am J Hypertens 1993; 6: 586–592

    Google Scholar 

  24. Mallion J.M., Meilhac B., Tremel F., et al. Use of a microprocessor equipped tablet box in monitoring compliance with anti-hypertensive treatment. J Cardiovasc Pharmacol 1992; 19 Suppl. 2: S41–S48

    Article  PubMed  Google Scholar 

  25. Eisen S.A., Woodward R.S., Miller D., et al. The effect of medication compliance on the control of hypertension. J Gen Intern Med 1987; 2: 298–305

    Article  PubMed  CAS  Google Scholar 

  26. Cramer J.A. Compliance with contraceptives and other treatments. Obstet Gynecol 1992; 88 (3 Suppl.): 45–125

    Google Scholar 

  27. Spector S.L., Mawhinney H. Aerosol inhaler monitoring of asthmatic medication. In: Cramer J.A., Spilker B., editors. Patient compliance in medical practice and clinical trials. New York; Raven 1991: 149–162

    Google Scholar 

  28. Mawhinney H., Spector S.L., Kinsman R.A., et al. Compliance in clinical trials of two nonbronchodilator, antiasthma medications. Ann Allergy 1991; 66: 294–299

    PubMed  CAS  Google Scholar 

  29. Milgrom H., Bender B., Ackerson L., et al. Noncompliance and treatment failure in children with asthma. J Allergy Immunol 1996; 98: 1051–1057

    Article  CAS  Google Scholar 

  30. Didlake R.H., Dreyfus K., Kerman R.H., et al. Patient noncompliance: a major cause of late graft failure in cyclosporine-treated renal patients. Transplant Proc 1988; 20: 63–69

    PubMed  CAS  Google Scholar 

  31. Rovelli M., Palmeri D., Vossler E., et al. Noncompliance in organ transplant recipients. Transplant Proc 1989; 21: 833–834

    PubMed  CAS  Google Scholar 

  32. Kass M.A., Gordon M., Morley R.E., et al. Compliance with topical timolol treatment. Am J Ophthalmol 1987; 103: 188–193

    PubMed  CAS  Google Scholar 

  33. Zuger A. The ‘other’ drug problem: forgetting to take them. The New York Times/Science Times 1998. Tuesday, June 2. Reprint by Scoop Media Services

    Google Scholar 

  34. Urquhart J. The electronic medication event monitor. Lessons for pharmacotherapy. Clin Pharmacokinet 1997; 32 (5): 345–356

    Article  PubMed  CAS  Google Scholar 

  35. Cramer J.A. Overview of methods to measure and enhance patient compliance. In: Cramer J.A., Spilker B., editors. Patient compliance in medical practice and clinical trials. New York: Raven 1991: 3–10

    Google Scholar 

  36. de Klerk E., van der Linden S., van der Heijde D., et al. Facilitated analysis of data on drug regimen compliance. Statistics in Medicine 1997; 16: 1653–1664

    Article  PubMed  Google Scholar 

  37. URL:http://giganano.com [Accessed 2000 Aug 8]

  38. Urquhart J., de Klerk E. Contending paradigms for the interpretation of data on patient compliance with therapeutic drug regimens. Statistics in Medicine 1998; 17: 251–267

    Article  PubMed  CAS  Google Scholar 

  39. URL:http://www.medtrac.com [Accessed 2000 Aug 8]

  40. URL:http://www.intelihealth.com/ipn/pcn/HN/alr/00235240.htm [Accessed 2000 Aug 8]

  41. Meredith P.A. Enhancing patients’ compliance — electronic monitoring approaches should be more widely used. BMJ 1998; 316 (7128): 393–394

    Article  PubMed  CAS  Google Scholar 

  42. Urquhart J. Role of patient compliance in clinical pharmacokinetics: review of recent research. Clin Pharmacokinet 1994; 27: 202–215

    Article  PubMed  CAS  Google Scholar 

  43. Urquhart J., Chevalley C. Impact of unrecognized dosing errors on the cost and effectiveness of pharmaceuticals. Drug Inf J 1988; 22: 363–378

    Google Scholar 

  44. Sullivan S.D., Dreling D.H., Hazlet T.K. Non-compliance with medication regimens and subsequent hospitalizations: a literature analysis and cost of hospitalization estimate. J Res Pharm Econ 1990; 2: 19–32

    Google Scholar 

  45. Rudd P., Lenert L. Pharmacokinetics as an aid to optimizing compliance with medications. Clin Pharmacokinet 1995; 28 (1): 1–6

    Article  PubMed  CAS  Google Scholar 

  46. Lacombe P.S., Vicente J.A.G., Pagès J.C., Morselli P.L. Causes and problems of nonresponse or poor response to drugs. Drugs 1996; 51 (4): 552–570

    Article  CAS  Google Scholar 

  47. Hammarström B., Wessling A., Nilsson J.L.G. Pharmaceutical care for patients with skin diseases: a campaign year at Swedish pharmacies 1995; 20: 327–334

    Google Scholar 

  48. Witkowski J.A. Compliance: the dermatologic patient. Int J Dermatol 1988; 27 (9): 608–611

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Dermatology, University of California, School of Medicine, San Francisco, California, 94143-0989, USA

    Almuth M. Koehler &  Howard I. Maibach

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  1. Almuth M. Koehler
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  2. Howard I. Maibach
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Correspondence to Howard I. Maibach.

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Koehler, A.M., Maibach, H.I. Electronic Monitoring in Medication Adherence Measurement. Am J Clin Dermatol 2, 7–12 (2001). https://doi.org/10.2165/00128071-200102010-00002

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