California Pacific Medical Center Research Institute, San Francisco, CA, USA.
J Addict Med. 2011 Sep;5(3):170-4. doi: 10.1097/ADM.0b013e3181fcb5fd.
Medication nonadherence is an important factor in clinical practice and research methodology. Although many methods of measuring adherence have been investigated, there is as yet no "gold standard." We compared the usefulness and accuracy of a novel measure of adherence, photographs taken by cellular telephones with 2 incumbents: capsule count and the Medication Event Monitoring System (MEMS).
Twenty subjects participated in a clinical trial of the efficacy of modafinil for the treatment of methamphetamine dependence. Subjects were issued cell phones and medication in MEMS Cap equipped bottles and were instructed to take 1 capsule a day for 8 weeks, recording adherence with both systems. Pill counts were recorded at weekly inpatient visits. Subjects were paid for participation and for each capsule photograph and the returned medication bottle with MEMS Cap.
Capsule count-indicated adherence (proportion of prescribed medication taken) was 94.9%. When compared with capsule count, the novel method was found to underestimate adherence, whereas MEMS overestimated adherence. By using the dosing time data collected, we determined that subjects who dosed at a consistent time daily were more likely to adhere to the prescribed regimen. We also detected discrepancies in the timestamps recorded by MEMS.
Capsule photographs are a useful measure of adherence, allowing more accurate time measures and more frequent adherence assessment than MEMS or capsule count. Given the ubiquity of cellular telephone use, and the relative ease of this adherence measurement method, we believe it is a useful and cost-effective approach.
药物依从性是临床实践和研究方法中的一个重要因素。尽管已经研究了许多测量依从性的方法，但目前还没有“金标准”。我们比较了一种新的依从性测量方法，即使用手机拍摄照片，与两种现有方法（胶囊计数和药物事件监测系统[MEMS]）的有效性和准确性。
20 名受试者参加了莫达非尼治疗甲基苯丙胺依赖的疗效临床试验。受试者被发放手机和 MEMS 帽装瓶中的药物，并被指示每天服用 1 粒胶囊，持续 8 周，并用两种系统记录依从性。每周住院就诊时记录胶囊计数。受试者因参与研究以及拍摄的每粒胶囊照片和带 MEMS 帽的返还药物瓶而获得报酬。
胶囊计数指示的依从性（服用规定药物的比例）为 94.9%。与胶囊计数相比，新方法被发现低估了依从性，而 MEMS 则高估了依从性。通过使用收集到的剂量时间数据，我们确定每天按时剂量的受试者更有可能遵守规定的治疗方案。我们还检测到 MEMS 记录的时间戳存在差异。
胶囊照片是一种有用的依从性测量方法，它可以提供更准确的时间测量值和更频繁的依从性评估，比 MEMS 或胶囊计数更有效。鉴于手机使用的普及性，以及这种依从性测量方法相对简单，我们认为它是一种有用且具有成本效益的方法。
