Abstract
This study examined the role of a Medication Event Monitoring System (MEMS) to assess pill-taking behavior and enhance compliance within a randomized trial of bupropion-SR for smoking cessation. Female participants (N = 97) received MEMS bottles containing bupropion-SR 150 mg or placebo, to be taken twice daily. A randomly selected “feedback” group of participants was told about the recording device in the bottle cap and received weekly graphic feedback showing their pill-taking behavior with specific instructions for improving compliance. A “no-feedback” group was not informed about the MEMS bottles, and did not receive further instruction or feedback beyond the standard dosing instructions. Compliance outcomes were the total doses taken and number of doses taken within the prescribed time interval. Results indicated significantly higher compliance over time for the feedback group. Participation in the feedback group predicted higher compliance beyond demographic, smoking, and health belief variables, suggesting significant benefit in providing brief feedback and instruction throughout the medication regimen.
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Abrams, D. B., Borrelli, B., Shadel, W. G., King, T., Bock, B., and Niaura, R. (1998). Adherence to treatment for nicotine dependence. In Shumaker, S. A. (Ed.), The Handbook of Health Behavior Change, 2nd ed., Springer, New York, pp. 137–165.
Adams, J., and Scott, J. (2000). Predicting medication adherence in severe mental disorders. Acta Psychiatr. Scand. 101: 119–124.
Aiken, L. S., West, S. G., Woodward, C. K., and Reno, R. R. (1994). Health beliefs and compliance with mammography-screening recommendations in asymptomatic women. Health Psychol. 13: 122–129.
Alterman, A. I., Gariti, P., Cook, T. G., and Cnaan, A. (1999). Nicodermal patch adherence and its correlates. Drug Alcohol Depend. 53: 159–165.
Babiker, I. E., Cooke, P. R., and Gillett, M. G. (1989). How useful is riboflavin as a tracer of medication compliance? J. Behav. Med. 12: 25–38.
Becker, M. H., and Maimon, L. A. (1975). Sociobehavioural determinants of compliance with health and medical care recommendations. Med. Care 13: 10–24.
Berg, J., Dunbar-Jacob, J., and Rohay, J. M. (1998). Compliance with inhaled medications: The relationship between diary and electronic monitor. Ann. Behav. Med. 20: 36–38.
Blondal, T., Franzon, M., and Westin, A. (1997). A double-blind randomized trial of nicotine nasal spray as an aid in smoking cessation. Eur. Respir. J. 10: 1585–1590.
Bosley, C. M., Fosbury, J. A., and Cochrane, G. M. (1995). The psychological factors associated with poor compliance with treatment in asthma. Eur. Respir. J. 8: 899–904.
Burnier, M., Schneider, M. P., Chiolero, A., Stubi, C. L., and Brunner, H. R. (2001). Electronic compliance monitoring in resistant hypertension: The basis for rational therapeutic decisions. J. Hypertens. 19: 335–341.
Carney, R. M., Freedland, K. E., Eisen, S. A., Rich, M. W., and Jaffe, A. S. (1995). Major depression and medication adherence in elderly patients with coronary artery disease. Health Psychol. 14: 88–90.
Claxton, A. J., Cramer, J., and Pierce, C. (2001). A systematic review of the associations between dose regimens and medication compliance. Clin. Ther. 23: 1296–1310.
Cramer, J. A., Mattson, R. H., Prevey, M. L., Scheyer, R. D., and Ouellette, V. L. (1989). How often is medication taken as prescribed? A novel assessment technique. JAMA 261: 3273–3277.
Cramer, J. A., Ouellette, V. L., and Mattson, R. H. (1990). Effect of microelectronic observation on compliance. Epilepsia 31: 617–618.
Cramer, J. A., and Rosenheck, R. (1999). Enhancing medication compliance for people with serious mental illness. J. Nerv. Ment. Dis. 187: 53–55.
Cramer, J. A., and Spilker, B. (Eds.). (1991). Patient Compliance in Medical Practice and Clinical Trials, Raven, New York.
Day, R., Cella, D. F., Ganz, P. A., and Constantino, J. P. (1998). Electronic monitoring of participant adherence in the NSABP breast cancer prevention trial. Control. Clin. Trials 19: 69S.
Del Boca, F. K., Kranzler, H. R., Brown, J., and Korner, P. F. (1996). Assessment of medication compliance in alcoholics through UV light detection of a riboflavin tracer. Alcohol Clin. Exp. Res. 20: 1412–1417.
Eisen, S. A., Woodward, R. S., Miller, D., Spitznagel, E., and Windham, C. A. (1987). The effect of medication compliance on the control of hypertension. J. Gen. Intern. Med. 2: 298–305.
Elixhauser, A., Eisen, S. A., Romeis, J. C., and Homan, S. M. (1990). The effects of monitoring and feedback on compliance. Med. Care 28: 882–893.
Elk, R., Grabowski, J., Rhoades, H., and McLellan, A. T. (1993). A substance-abuse research-treatment clinic: Effective procedures and systems. J. Subst. Abuse Treat. 10: 459–471.
Garvey, A. J., Kinnunen, T., Nordstrom, B. L., Utman, C. H., Doherty, K., Rosner, B., and Vokonas, P. S. (2000). Effects of nicotine gum dose by level of nicotine dependence. Nicotine Tob. Res. 2: 53–63.
Glasgow, R. E., and Orleans, C. T. (1997). Adherence to smoking cessation regimens. In Shumaker, S. A. (Ed.), Handbook of Health Behavior Research II: Provider Determinants, Plenum, New York, pp. 353–377.
Gonzales, D., Bjornson, W., Durcan, M., White, J., Johnston, J., Buist, A., and Hurt, R. D. (2002). Effects of gender on relapse prevention in smokers treated with bupropion SR. Am. J. Prev. Med. 22(4): 234–239.
Haefner, D. P., and Kirscht, J. P. (1970). Motivational and behavioral effects of modifying health beliefs. Public Health Rep. 85: 478–484.
Hajek, P., West, R., Foulds, J., Nilsson, F., Burrows, S., and Meadow, A. (1999). Randomized comparative trial of nicotine polacrilex, a transdermal patch, nasal spray, and an inhaler. Arch. Intern. Med. 159: 2033–2038.
Hurt, R. D., Sachs, D. P., Glover, E. D., Offord, K. P., Johnston, J. A., Dale, L. C., Khayrallah, M. A., Schroeder, D. R., Glover, P. N., Sullivan, C. R., Croghan, I. T., and Sullivan, P. M. (1997). A comparison of sustained-release bupropion and placebo for smoking cessation. N. Engl. J. Med. 337(17): 1195–1202.
Jamerson, B. D., Nides, M., Jorenby, D. E., Donahue, R., Garrett, P., Johnston, J. A., Fiore, M. C., Rennard, S. I., and Leischow, S. J. (2001). Late-term smoking cessation despite initial failure: An evaluation of bupropion sustained release, nicotine patch, combination therapy, and placebo. Clin. Ther. 23: 744–752.
Jorenby, D. E., Leischow, S. J., Nides, M. A., Rennard, S. I., Johnston, J. A., Hughes, A. R., Smith, S. S., Muramoto, M. L., Daughton, D. M., Doan, K., Fiore, M. C., and Baker, T. B. (1999). A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N. Engl. J. Med. 340(9): 685–691.
Kegeles, S. S. (1969). A field experimental attempt to change beliefs and behavior of women in an urban ghetto. J. Health Soc. Behav. 10: 115–124.
Kelly, G. R., Mamon, J. A., and Scott, J. E. (1987). Utility of the health belief model in examining medication compliance among psychiatric outpatients. Soc. Sci. Med. 25: 1205–1211.
Lee, C. R., Nicholson, P. W., Ledermann, J. A., and Rustin, G. J. (1996). Patient compliance with prolonged oral altretamine treatment in relapsed ovarian cancer. Eur. J. Gynaecol. Oncol. 17: 99–103.
Littell, R. C., Milliken, G. A., Stroup, W. W., and Wolfinger, R. S. (1996). SAS System for Mixed Models, SAS Institute, Cary, NC.
Matsui, D., Hermann, C., Klein, J., Berkovitch, M., Olivieri, N., and Koren, G. (1994). Critical comparison of novel and existing methods of compliance assessment during a clinical trial of an oral iron chelator. J. Clin. Pharmacol. 34: 944–949.
Mawhinney, H., Spector, S. L., Kinsman, R. A., Siegel, S. C., Rachelefsky, G. S., Katz, R. M., and Rohr, A. S. (1991). Compliance in clinical trials of two nonbronchodilator, antiasthma medications. Ann. Allergy 66: 294–299.
McKenney, J. M., Munroe, W. P., and Wright, J. T., Jr. (1992). Impact of an electronic medication compliance aid on long-term blood pressure control. J. Clin. Pharmacol. 32: 277–283.
Melbourne, K. M., Geletko, S. M., Brown, S. L., Willey-Lessne, C., Chase, S., and Fisher, A. (1999). Medication adherence in patients with HIV infection: A comparison of two measurement methods. AIDS Read. 9: 329–338.
Mickey, R. M., and Greenland, S. (1989). The impact of confounder selection criteria on effect estimation. Am. J. Epidemiol. 129: 125–137.
Millard, R. W., Waranch, H. R., and McEntee, M. (1992). Compliance to nicotine gum recommendations in a multicomponent group smoking cessation program: An exploratory study. Addict. Behav. 17: 201–207.
Nides, M. A., Tashkin, D. P., Simmons, M. S., Wise, R. A., Li, V. C., and Rand, C. S. (1993). Improving inhaler adherence in a clinical trial through the use of the nebulizer chronolog. Chest 104: 501–507.
O’Malley, S. S., Jaffe, A. J., Chang, G., Schottenfeld, R. S., Meyer, R. E., and Rounsaville, B. (1992). Naltrexone and coping skills therapy for alcohol dependence. A controlled study. Arch. Gen. Psychiatry 49: 881–887.
Pullar, T., Kumar, S., Tindall, H., and Feely, M. (1989). Time to stop counting the tablets? Clin. Pharmacol. Ther. 46: 163–168.
Rudd, P., Byyny, R. L., Zachary, V., LoVerde, M. E., Titus, C., Mitchell, W. D., and Marshall, G. (1989). The natural history of medication compliance in a drug trial: Limitations of pill counts. Clin. Pharmacol. Ther. 46: 169–176.
Russell, M. A., Stapleton, J. A., Feyerabend, C., Wiseman, S. M., Gustavsson, G., Sawe, U., and Connor, P. (1993). Targeting heavy smokers in general practice: Randomised controlled trial of transdermal nicotine patches. BMJ 306: 1308–1312.
SAS Institute Inc. (2002). The SAS System for Windows, Version 8.2, SAS Institute, Cary, NC.
Schmitz, J. M., Day, S. L., Stotts, A. L., Davis, C., Rhoades, H. M., and Grabowski, J. (1998, June). Using riboflavin to assess the validity of self-reported medication compliance in a double-blind pharmacotherapy trial. In 60th Annual Scientific Meeting of the College on Problems of Drug Dependence, Scottsdale, AZ.
SPSS Inc. (1998). SPSS for Windows, Version 9.0, SPSS, Chicago, IL.
Tonnesen, P., Norregaard, J., Mikkelsen, K., Jorgensen, S., and Nilsson, F. (1993). A double-blind trial of a nicotine inhaler for smoking cessation. JAMA 269: 1268–1271.
Urquhart, J. (1992). Ascertaining how much compliance is enough with outpatient antibiotic regimens. Postgrad. Med. J. 68: S49--S58; discussion S59.
Vitolins, M. Z., Rand, C. S., Rapp, S. R., Ribisl, P. M., and Sevick, M. A. (2000). Measuring adherence to behavioral and medical interventions. Control. Clin. Trials 21: 188S--194S.
Volpicelli, J. R., Alterman, A. I., Hayashida, M., and O’Brien, C. P. (1992). Naltrexone in the treatment of alcohol dependence. Arch. Gen. Psychiatry 49: 876–880.
Wall, T. L., Sorensen, J. L., Batki, S. L., Delucchi, K. L., London, J. A., and Chesney, M. A. (1995). Adherence to zidovudine (AZT) among HIV-infected methadone patients: A pilot study of supervised therapy and dispensing compared to usual care. Drug Alcohol Depend. 37: 261–269.
Waterhouse, D. M., Calzone, K. A., Mele, C., and Brenner, D. E. (1993). Adherence to oral tamoxifen: A comparison of patient self-report, pill counts, and microelectronic monitoring. J. Clin. Oncol. 11: 1189–1197.
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Schmitz, J.M., Sayre, S.L., Stotts, A.L. et al. Medication Compliance During a Smoking Cessation Clinical Trial: A Brief Intervention Using MEMS Feedback. J Behav Med 28, 139–147 (2005). https://doi.org/10.1007/s10865-005-3663-4
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DOI: https://doi.org/10.1007/s10865-005-3663-4