Pharmacists' interventions using an electronic medication-event monitoring device's adherence data versus pill counts.

OBJECTIVE

To compare adherence data from an electronic medication-event monitoring device (MEMS, Aprex) with pill counts in assisting pharmacists in making recommendations regarding diabetes therapy.

DESIGN

Two-month, double-blind, randomized, controlled trial.

SETTING

Veterans Affairs Medical Center ambulatory care clinics.

PATIENTS

Forty-seven patients with poor to fair metabolic control of diabetes mellitus were enrolled. Patients were excluded if they were receiving insulin, had a concurrent infection, required child-resistant caps or medication remainder devices, or could not return for followup visits. Twenty patients were randomized to the MEMS and 27 to the control group (pill counts). Fasting plasma glucose concentrations were measured monthly and glycohemoglobin concentrations were measured at baseline and 60 days. Thirty-two patients were evaluable: 15 using MEMS and 17 using pill counts.

INTERVENTION

Investigators made pharmacologic or educational recommendations to the patient's healthcare provider based on both laboratory data and MEMS readings in the treatment group or laboratory data and pill counts in the control group.

MAIN OUTCOME MEASURE

Quantities and types of recommendations regarding diabetes therapy made by pharmacists using adherence data from the two methods were tabulated.

RESULTS

In the MEMS group, 47 percent of the recommendations related to patient education compared with 12 percent in the control group (p = 0.028). MEMS data would have changed four recommendations in the control group to involve patient education.

CONCLUSIONS

MEMS data resulted in different numbers and types of recommendations than pill counts. Pharmacists then could make specific recommendations regarding patient education before resorting to pharmacologic manipulations.