Many electronic adherence monitoring devices accurately assess medication adherence behavior, but identifying the most suitable device requires that clinicians and researchers consider their patient population, as well as their research or clinical objectives, according to the results of a study published in the Annals of Internal Medicine.

Approximately 50% of patients fail to adhere to their medication regimen.

Nonadherence is a major cause of treatment failure, morbidity, and mortality, resulting in an estimated $300 billion of avoidable medical costs in the United States every year.

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To determine whether electronic adherence monitoring devices are effective, Meghan E. McGrady, PhD, of the Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine in Ohio, and colleagues, identified and purchased 4 each of 10 electronic adherence monitoring devices and tested them according to a 21-day protocol involving twice-daily medication prescribed 7 days per week.

Each protocol simulated 4 adherence patterns: perfect adherence; nonadherence, additional doses; nonadherence, missed doses; and device non-use. The primary measure of device efficacy was the number of electronic adherence monitoring device-registered openings out of 25 that fell within 120 seconds of the date and time anticipated.

Of the 10 electronic adherence monitoring devices, 7 accurately registered at least 24 of 25 openings. However, the study investigators pointed out that the best electronic adherence monitoring device for a particular application depends on a number of factors, including the characteristics of the patient population, such as medication number and size, medication schedule, and patient preferences. Choosing a device that is consistent with patient characteristics may enhance patient acceptance and uptake.

Another consideration is geographic area. Certain devices required cellular connectivity, which may be a problem in some locations. Electronic adherence monitoring devices features should also be consistent with the clinical or research goals; for example, if passive adherence monitoring is the goal, then the use of an electronic adherence monitoring device with a reminder may not be the best choice. Budget is yet another consideration, as electronic adherence monitoring devices vary widely in price.

The researchers noted that the study was limited by their inability to test all available electronic adherence monitoring devices, as well as the controlled laboratory environment in which the testing took place. In addition, not all features and functions of the electronic adherence monitoring devices were activated.


McGrady ME, Holbein CE, Morrison CF, Hommel KA. An independent evaluation of the accuracy and usability of electronic adherence monitoring devices [published online May 22, 2018]. Ann Intern Med. doi:10.7326/M17-3306