Electronic monitoring of patient adherence to oral antihypertensive medical treatment: a systematic review

Abstract

Poor patient adherence is often the reason for suboptimal blood pressure control. Electronic monitoring is one method of assessing adherence. The aim was to systematically review the literature on electronic monitoring of patient adherence to self-administered oral antihypertensive medications. We searched the Pubmed, Embase, Cinahl and Psychinfo databases and websites of suppliers of electronic monitoring devices. The quality of the studies was assessed according to the quality criteria proposed by Haynes et al. Sixty-two articles were included; three met the criteria proposed by Haynes et al. and nine reported the use of electronic adherence monitoring for feedback interventions. Adherence rates were generally high, whereas average study quality was low with a recent tendency towards improved quality. One study detected investigator fraud based on electronic monitoring data. Use of electronic monitoring of patient adherence according to the quality criteria proposed by Haynes et al. has been rather limited during the past two decades. Electronic monitoring has mainly been used as a measurement tool, but it seems to have the potential to significantly improve blood pressure control as well and should be used more widely.

Evaluation of Adherence Should Become an Integral Part of Assessment of Patients With Apparently Treatment-Resistant Hypertension

“…60,61 Accordingly, it has been associated with improved drug adherence. 57,58,[60][61][62] Nevertheless, electronic monitoring has an important limitation: it does not allow detecting patients who willingly open the box without swallowing the pill. Such behavior may be over-represented in the subgroup of difficult-to-treat patients referred for RDN.…”

Measuring, Analyzing, and Managing Drug Adherence in Resistant Hypertension

“…22 Electronic monitoring methods have followed several approaches, starting with eye drop dispensing in the treatment of sight-threatening glaucoma and ocular hypertension 23,24 and then into orally administered tablets or capsules. Two approaches to electronic monitoring of orally administered drugs have been developed: medication event monitoring system (MEMS; AARDEX Group, Ltd, Sion, Switzerland), which time stamps and stores times/dates of each opening of the drug package 13,16 and the recent innovation by Proteus Digital Health Inc (Redwood City, CA), which incorporates into each dose of drug a specially designed microchip that, on ingestion and solubilization, emits a brief, low-strength, radio signal that is detected, amplified, and transmitted onward by an adhesive patch worn by the patient.…”

“…[17][18][19] Several studies have been conducted in the field of hypertension using the MEMS monitoring system, including in resistant hypertension. 22,[26][27][28] What Lessons Have We Learned About Patient Adherence, its Detection, and its Analysis?…”

Non-adherence to antihypertensive medication is very common among resistant hypertensives: results of a directly observed therapy clinic

“…Examples of indirect methods include retrospective analysis of prescription refill records, pill-counting of returned untaken doses, automatic electronic time-stamping of package opening, patient questionnaires and interviews. 18,19 Direct methods include directly observed administration of medications, analysis of chemical markers of drug in urine or serum and more recently automatic electronic monitoring of drug ingestion by incorporating a specially designed microchip within each dose of a drug. 20 Indirect methods especially pill-counting and prescription refill rates are unreliable and consistently overestimate patients' adherence, as patients discard or hoard untaken medications.…”