Electronic Monitoring Data Research Articles

Evaluating the Consistency of Pharmacotherapy Exposure by Use of State-of-the-Art Techniques

The authors examine the usefulness of population pharmacokinetics coupled with electronic compliance monitoring in evaluating consistency of exposure to pharmacotherapy. Adherence to pharmacotherapy can have a significant impact on drug response, especially in the treatment of schizophrenia and depression. Previous studies evaluating antipsychotics identified schizophrenic individuals with poor pharmacotherapy adherence as having a higher risk of rehospitalization. Other investigators have shown a relationship between pattern of taking selective serotonin-reuptake inhibitors (SSRIs) and probability of a positive outcome. Therefore, it is important to measure adherence patterns in clinical trials evaluating these treatments and to incorporate this information into the research findings. Two multisite trials with atypical antipsychotics and antidepressants were simulated to evaluate, by use of population pharmacokinetic methods, the impact of electronic monitoring on measuring consistency of exposure to pharmacotherapy. One of the trials is ongoing and evaluates exposure to atypical antipsychotics, and the other is a proposed trial that examines exposure to an SSRI. Erratic exposure patterns were detected with population pharmacokinetic techniques in the absence of Electronic Medication Event Monitoring (MEMS) data. In our simulations, the use of electronic monitoring improved the identification of atypical exposure by population pharmacokinetics both for the atypical antipsychotics and SSRIs. Our simulations demonstrate the potential usefulness of the combination of population pharmacokinetics with electronic monitoring as a robust method for accurately and precisely capturing both magnitude and consistency of pharmacotherapy exposure.

Measuring Patient Adherence

Letters2 July 2002Measuring Patient AdherenceBarbara J. Turner, MD and Frederick M. Hecht, MDBarbara J. Turner, MDUniversity of Pennsylvania, Philadelphia, PA 19104 (Turner)San Francisco General Hospital, San Francisco, CA 94410 (Hecht)Search for more papers by this author and Frederick M. Hecht, MDUniversity of Pennsylvania, Philadelphia, PA 19104 (Turner)San Francisco General Hospital, San Francisco, CA 94410 (Hecht)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-137-1-200207020-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate the thoughtful comments of Dr. Liu and his coauthors. We understand that the authors feel that their adherence score reflects a composite of several approaches to measure adherence. However, the authors first used electronic monitor data and then filled in missing data points with pill count and, finally, interview data. Our editorial aimed to help the reader understand that electronic monitor data served as the centerpiece of this approach. If a researcher had nearly complete adherence data on his or her study participants from electronic monitors, Liu and colleagues' approach would require minimal additional data from ...

Comparison of AC electronic monitoring and field data for estimating tolerance to Empoasca kraemeri (Homoptera: Cicadellidae) in common bean genotypes.

Two methods for estimating the tolerance of common bean genotypes to Empoasca kraemeri Ross & Moore were compared, using a yield trial carried out at Centro Internacional de Agricultura Tropical (CIAT), Cali, Colombia, versus stylet penetration tactics measured by AC electronic feeding monitors. A stylet penetration index was devised based on principal component scores of three penetration tactics identified (pulsing laceration, cell rupturing, and lancing sap ingestion), combined with knowledge of the hopperburn symptoms caused by each tactic. Tolerant genotypes, as classified by the CIAT yield index, showed significantly more unprotected yield and lower hopperburn scores than the susceptible control. They also induced performance of less pulsing laceration (the tactic considered most damaging to the plant), and more of the other two, mitigating tactics, especially cell rupturing. When index values were calculated for each genotype, stylet penetration index values matched those of the yield index for three out of five genotypes: two EMP-coded tolerant lines ('EMP 385' and 'EMP 392') and the susceptible control 'BAT 41'. Thus, for these three genotypes, all subsequent hoppereburn symptoms are predictable by the type of feeding behavior performed on them. 'Porrillo Sintético' and 'EMP 84', considered borderline genotypes by the yield index, were overestimated and underestimated respectively, by the stylet penetration index. We postulate that, for these two genotypes, plant physiological responses to feeding (either compensatory or heightened sensitivity, respectively) synergize with type of feeding performed to generate the overall hopperburn condition. This multivariate analysis of electronic monitoring data was successfully used to devise an index of resistance. The implications of using the stylet penetration index and the advantages of using electronic monitoring in a bean-breeding program are discussed.

Validation of patient reports, automated pharmacy records, and pill counts with electronic monitoring of adherence to antihypertensive therapy.

To evaluate the validity of patient report, pharmacy dispensing records, and pill counts as measures of antihypertensive adherence using electronic monitoring as the validation standard. The study was conducted among 286 members of Harvard Pilgrim Health Care, a managed care organization, who were at least 18 years of age, on monotherapy for hypertension, and had prescription drug coverage. Prescription refill adherence during the 12 months before enrollment was determined from their automated pharmacy dispensing records. Participants were interviewed about their medication adherence before and after a 3-month electronic monitoring period during which pill counts were also performed. Adherence to both recommended number and timing of doses was estimated from electronic monitoring data. Data analysis was based on statistical correlation and analysis of variance. Electronic adherence monitoring revealed that the proportion of prescribed doses consumed was higher (0.92) than the proportion of doses taken on time (0.63). The correlation between adherence to quantity and timing of doses was 0.32. Concurrent pill counts and earlier refilling patterns were moderately correlated with electronic monitoring (pill count: r = .52 with quantity and r = .17 with timing; refill adherence r = .32 with quantity and r = .22 with timing). There was considerable misclassification of adherence reported by patients, although nonadherence was generally accurately reported. Deviation from recommended timing of doses appears to be greater than from prescribed number of doses. Pharmacy dispensing records demonstrate predictive validity as measures of cumulative exposure and gaps in medication supply. Adherence levels determined from pill counts and pharmacy dispensing records correlate more closely with quantity than with timing of doses. Nonadherence reported by patients can serve as a qualitative indicator and predictor of reduced adherence.

The problem of compliance to cholesterol altering therapy.

This review's purpose is to describe for the practicing clinician the current knowledge about patient compliance to cholesterol-altering drugs and about procedures for compliance management applicable to clinical practice in the United States. Compliance is defined for four commonly measured major steps and, based on recent electronic monitoring data, for three quantitative categories of active medication-taking. The concepts and definition of compliance are undergoing evolutionary changes due to the measurement and availability of new dimensions through electronic monitoring of patient compliance. Substantial non-compliance to cholesterol-altering drugs has been reported in nine large clinical trials for primary and secondary prevention of coronary heart disease, in two HMOs, and, using electronic monitoring of compliance, in one clinical trial and a selected practice. The risks of treatment discontinuation increased continuously during treatment and totaled from 6 to 30% after 5 years. Patterns of day-to-day partial compliance are emerging. Procedures and knowledge for clinical management of compliance are described including methods of measuring compliance, risk factors for non-compliance, standards for compliance performance, epidemiology of compliance, procedures for managing compliance at the start of therapy and for addressing compliance problems during established treatment, simple office assessment of compliance by brief interview questions, compliance aids, prediction of compliance, and education and training of medical-care personnel in compliance management.

Clinicians and patients with hypertension: Unsettled issues about compliance

Ambulatory treatment of hypertension depends largely on long-term oral medications to lower blood pressure and delay or prevent cardiovascular morbidity and mortality. Failure to achieve the therapeutic goal may reflect biologic, pharmacologic, or behavioral factors. Ignoring behavioral factors may result in unnecessary or even dangerous regimen escalation. More than half of patients with insufficient reductions in blood pressure display suboptimal medication compliance as assessed by pill count or bioassay. 16, 19 Once-daily dosing may be an important part of enhancing compliance, patient convenience, and regimen simplification; however, drug concentrations may be subtherapeutic when dosing delays or omissions occur. Electronic monitoring data in hypertension, glaucoma, seizure disorders, and other diseases indicate that 50% to 60% of patients adhere well to prescribed regimens, that 5% to 10% adhere poorly, and that the 30% to 45% adhere to an intermediate but markedly variable degree. 35–40 A growing body of literature offers empirical support for focused and personalized interventions.

The bubble, drop and particle unit: A second-generation fluid physics facility

The objectives of the Bubble, Drop and Particle Unit (BDPU) can be summarised as follows: Investigation into hydrostatics, dynamics, thermodynamics, electrodynamics, and more generally the dynamics of two phase mixtures. As a middle course between dedicated autonomy and multi-purpose usage, a modular approach has been adopted that should allow assembly into ‘as required facilities’ that can be reconfigured between flights to accommodate the mission's peculiar requirements of the investigators. The concept is centered around a service module which provides electronic control and monitoring data management, power supply, stimuli and diagnostic services. Interchangeable diagnostic modules will be available with a particular emphasis on the use of laser techniques.