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Electronic monitoring of medication adherence in skin disease: Results of a pilot study

https://doi.org/10.1067/S0190-9622(03)00912-5Get rights and content

Abstract

Background

Traditional medication adherence monitoring for topical medication use in dermatology relies heavily on measures of self-reporting and ointment tube weight, which are susceptible to various biases.

Methods

We first assessed the feasibility of using medication electronic monitoring system caps with cream, ointment, and gel formulations. We then performed a pilot study using 10 patients given a diagnosis of psoriasis with a weekly follow-up visit. Topical salicylic acid 6% was supplied to patients in medication jars with caps that recorded the opening and closing of the bottles, without patient knowledge.

Results

Medication electronic monitoring system cap monitors accurately recorded the opening and closing of bottles of topical agents. Patients overreported adherence in patient logs, and there was greater detection of missed doses using electronic monitors than self-reporting through patient log (relative risk = 6.2, 95% confidence interval: 1.13, 34.09).

Conclusion

Electronic monitoring shows promise as a more accurate form of measuring treatment adherence to topical medication regimens.

Section snippets

Methods

The MEMS cap is a medication bottle cap that has a microprocessor inside and has the ability to record the time and date of every opening of the bottle. The cap fits standard pharmacy bottles, and opens and closes just like a standard bottle. It can record up to 1800 dose events and has a battery life of 18 months. Although the MEMS cap is noted to be waterproof by the company, no studies have been done to test the caps usage with topical therapies such as gels, creams, or ointments.

As a

Results

During the testing phase before patient use, we found that the MEMS caps were able to keep an accurate record of all events using the 6 bottles with topical therapies. We tested stability of medication using ointments, gels, and creams, and found that if properly opened and closed, medication remained stable during a 4-week period. We also found that the monitors were able to accurately record the opening and closing of the bottles, and the software was able to download this information

Discussion

The results of this pilot study shed light on the potential advantages and disadvantages of the electronic monitors for measuring treatment adherence in skin disease. Potential advantages seem to include recording greater number of missed doses and decreased likelihood of reporting biases. Disadvantages include restriction to clinical research settings for the time being (costs, instructions on use) and potential inappropriate medication container use affecting medication stability, recording

Acknowledgements

We thank Vishal Khanna and Ann McCarthy for project assistance.

References (11)

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Supported in part by Fujisawa Healthcare Inc, Deerfield Ill, and through the Center for Dermatology Research, Wake Forest University Health Sciences.

Conflicts of interest: None identified.

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