The challenges of using medication event monitoring technology with pediatric transplant patients

Abstract

This study investigated the advantages and challenges of using Medication Electronic Monitoring System (MEMS) technology to examine adherence among pediatric kidney transplant patients. Twenty-nine patients participated in the study, with a mean age of 14.03 yr (SD = 3.34, range 8-19 yr). Patients were given a MEMS bottle and cap to be used with their primary immunosuppressant medication over a three-month period. Issues related to study eligibility, recruitment, and participant maintenance were recorded. Patients completed the Debriefing Form regarding their experiences with the MEMS. Many younger patients were on liquid medications affecting the feasibility of this technology across ages. Acceptance of this technology proved difficult, as many patients either declined upfront or dropped out because they did not want to use the MEMS. Of the final sample, 41% found transferring medication into the MEMS bottle difficult and 27.2% reported that the MEMS was a burden and/or difficult to transport. Another 22% of the patients reported that using the MEMS changed their routine, and 10.2% worried about missing their medications. Pediatric transplant centers should be cautious about solely relying on MEMS to examine adherence until more research is conducted on the feasibility, acceptance, and utility of this technology.

Measuring adherence to antiretroviral therapy in northern Tanzania: feasibility and acceptability of the Medication Event Monitoring System

“…Whereas we found that the MEMS-bottle was readily accepted by patients on ART, other studies found that some patients, especially those who prefer not to disclose their HIV-status, do not like the white, bulky appearance of the MEMS for privacy concerns [18-20]. The high acceptability of MEMS-use by patients in the current study is particularly remarkable because fears of disclosure of one's HIV-status and consecutive stigmatization are widely present in Tanzania and patients prefer to carry their medication as discretely as possible [21,22].…”

The Medication Level Variability Index (MLVI) Predicts Poor Liver Transplant Outcomes: A Prospective Multi-Site Study

“…18 On the other hand, objective methods, such as pill counts or electronic monitoring, frequently impose additional burden on the patient, and may require significant logistic support. 19,20 Increased patient burden matters because nonadherent patients are not likely to cooperate with a procedure that increases their burden. A patient who finds it hard to take the medications as prescribed, will probably also find it hard to bring the pill bottle to clinic, or use an electronic monitor.…”

“…A patient who finds it hard to take the medications as prescribed, will probably also find it hard to bring the pill bottle to clinic, or use an electronic monitor. 19,20 Resource-allocation barriers as well as difficulties in engaging the very segment of the population that should be monitored, 20 limits the use a robust adherence monitoring plan. 18, 21, 22 There is particular interest in identifying simple objective methods allowing efficient targeting of at-risk patients via algorithms built into standard care.…”

Adherence to immunosuppressants: how can it be improved in adolescent organ transplant recipients?

“…MEMS® technology provides continuous data and allows for the detection of temporal patterns of adherence. Yet, barriers associated with MEMS® technology include cost and the possibility that these devices may interfere with established adherence-promoting routines, such as the use of pillbox organizers (19). …”