Use of an electronic medication monitoring device to estimate medication adherence in kidney transplant patients

Electronic medication monitoring devices (EMD) have been used as a gold standard for assessing medication adherence. We used a wireless EMD (SimpleMed+), assessed its usability in patients after kidney transplantation (KTx), evaluated adherence, and analyzed concordance with other adherence measures. Fifty-five patients (53% female, mean age 46 years) at least 6 months after KTx agreed to use the EMD over a period of 8 weeks. Self-reported adherence was measured with the BAASIS, and immunosuppressant trough level variability was assessed prior to and again during the study period. Fourteen patients stopped using the EMD or were low users (<70%). These non-completers reported that using the EMD would interfere with their daily activities. Taking-adherence of the completers was high with 98.3% (±1.9) over the entire study period. Timing-adherence was somewhat lower (94.6% ± 7.9) and decreased during the second half of the study. We found statistically significant correlations between EMD results and self-reported adherence with moderate effect sizes, but no significant association with trough level variability. The low usage of the EMD supports the need to assess the practicability of an EMD before applying it in research and clinical routine. Taking- and timing-adherence of KTx patients using the EMD was satisfactory. Self-reported adherence might be a good enough estimate of medication adherence.

Parent Experiences with Electronic Medication Monitoring in Pediatric Asthma: A Qualitative Study (Preprint)

BACKGROUND Electronic medication monitoring (EMM) is a digital tool that can be used for tracking daily medication use. Previous studies of EMM in asthma have examined experiences of adults or have studied pediatric interventions that use EMM for less than a year. To understand acceptance of an EMM-enhanced intervention, we explore the experiences of parents of children with asthma, recruited from outpatient practices for a 12-month intervention trial. OBJECTIVE Through qualitative inquiry, we studied: (1) How did using the intervention change parents/caregivers’ experiences of managing their child’s asthma, and (2) What do parents recommend for improving the intervention in the future? METHODS Parents were recruited from the intervention arm of a multi-component, health intervention enhanced by Bluetooth-enabled sensors placed on inhaler medications. Semi-structured interviews were conducted with 20 parents of children with asthma (4-12 years old). Interviews were audio-recorded, transcribed, and inductively analyzed using a constant comparative approach. RESULTS Interview participants reflected an even mix of publicly and privately insured children and a diverse racial-ethnic demographic. Parents discussed six key themes related to their experience with the EMM-enhanced intervention: compatibility with their lifestyle, the impact on asthma management, impact on their child’s health, emotional impact of the intervention, children’s engagement in asthma management with the intervention, and recommendations for future intervention design. CONCLUSIONS Our qualitative study of parents found that the intervention with EMM over 12 months was overall compatible with their daily lives, positively influenced their preventive and acute asthma management, and promoted child engagement. Parents in our study found the intervention acceptable and generally favorable. While use of technology-enhanced tools are increasingly popular in healthcare delivery and consumer health care, our study highlighted that careful attention must also be paid to the unique needs of parents of children with asthma and understanding how a digital tool can be adopted into their daily disease management.