***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 , r and omized , 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 reminder devices , or could not return for follow-up visits . Twenty patients were r and omized 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 result ed in different numbers and types of recommendations than pill counts . Pharmacists then could make specific recommendations regarding patient education before resorting to pharmacologic manipulations This study examined the role of a Medication Event Monitoring System ( MEMS ) to assess pill-taking behavior and enhance compliance within a r and omized trial of bupropion-SR for smoking cessation . Female participants ( N = 97 ) received MEMS bottles containing bupropion-SR 150 mg or placebo , to be taken twice daily . A r and omly selected “ feedback ” group of participants was told about the recording device in the bottle cap and received weekly graphic feedback showing their pill-taking behavior with specific instructions for improving compliance . A “ no-feedback ” group was not informed about the MEMS bottles , and did not receive further instruction or feedback beyond the st and ard dosing instructions . Compliance outcomes were the total doses taken and number of doses taken within the prescribed time interval . Results indicated significantly higher compliance over time for the feedback group . Participation in the feedback group predicted higher compliance beyond demographic , smoking , and health belief variables , suggesting significant benefit in providing brief feedback and instruction throughout the medication regimen Objective The goal of this study was to evaluate clinical ly the acceptability of the IDAS II ( Intelligent Drug Administration System ) , a new electronic device that enables drug adherence monitoring . Methods IDAS II was compared to another electronic monitor , the Medication Event Monitoring System ( MEMS ) in a r and omised two-way cross-over study involving 24 hypertensive patients treated with irbesartan .  Patients used each device for 2 months . The main parameter of evaluation was the patients ’ opinion on both devices . Rates of adherence and blood pressure were also assessed . Results Most patients considered both devices to be reliable reminders ( IDAS II : 75%;MEMS : 84 % , p = ns ) . Ten patients ( 42 % ) preferred the MEMS , while 11 ( 46 % ) preferred the IDAS II ; three ( 12 % ) expressed no preference . Patients found the MEMS device easier to use than the IDAS device ( p < 0.001 ) but appreciated the IDAS blister packs better than the MEMS bulk packaging ( p < 0.01 ) . Over the 4-month period , the median “ taking adherence ” was excellent ( 99.2 % ) and comparable with both devices . However , the regularity of drug intake timing was higher with the IDAS II ( p < 0.01 ) . Conclusion IDAS II , a new electronic device enabling drug adherence monitoring without reconditioning of the drugs appears to be a well-accepted device . Overall , practicability and acceptability of the IDAS II and the MEMS device were similar . Thus , IDAS II could be a useful tool for the management of long-term therapies Background and Objectives : Older adults ' adherence to antihypertensive medications is far lower than what is considered necessary for clinical effectiveness , despite the risks for adverse cardiovascular events from uncontrolled blood pressure ( BP ) in the elderly . This pilot study tested a novel 8-week behavioral feedback intervention to improve antihypertensive medication adherence ( MA ) and BP control among older adults on existing treatment for hypertension . Methods : Adults 60 years old , or older taking at least 1 antihypertensive medication were r and omized to receive the nurse-delivered adherence intervention or usual care . Medication adherence was monitored continuously using electronic monitoring for 20 weeks . Intervention-group participants received biweekly MA and BP feedback , habit counseling , medication and disease education , a medication instruction card , and were given an electronic medication bottle cap with a digital display that provided daily adherence feedback during the 8-week intervention . Blood pressure was measured by a nurse at 12 and 20 weeks after r and omization . Adherence and BP outcomes were described using descriptive statistics and analyzed for between- and within-group differences using Mann-Whitney U tests . Results : Fifteen participants ( median age , 71 years ; 73 % female ) were eligible for r and omization . Participants took an average of 5.8 prescription medications and 2.93 over-the-counter medications per day . A nonsignificant difference was noted in baseline MA between groups . At the end of the intervention , the treatment group had better antihypertensive MA than did the control group ( median MA : 100 % vs 27.3 % , U = 5.00 , P = .013 ) . Systolic BP improved slightly in the intervention group during the study and was significantly different at week 12 ( median systolic BP : 130 vs 152 mm Hg ; U = 4.50 , P = .008 ) . Diastolic BP was largely unchanged over the course of the study . Conclusion : The results indicate that the intervention had a positive effect on MA . Additional testing is needed to further evaluate the intervention and its effect on adherence behavior and BP control Background Innovative approaches are needed to support patients ' adherence to drug therapy . The Real Time Medication Monitoring ( RTMM ) system offers real time monitoring of patients ' medication use combined with short message service ( SMS ) reminders if patients forget to take their medication . This combination of monitoring and tailored reminders provides opportunities to improve adherence . This article describes the design of an intervention study aim ed at evaluating the effect of RTMM on adherence to oral antidiabetics . Methods / Design R and omised Controlled Trial ( RCT ) with two intervention arms and one control arm involving diabetes type 2 patients with suboptimal levels of adherence to oral antidiabetics ( less than 80 % based on pharmacy refill data ) . Patients in the first intervention arm use RTMM including SMS reminders and a personal webpage where they can monitor their medication use . Patients in the second intervention arm use RTMM without SMS reminders or webpage access . Patients in the control arm are not exposed to any intervention . Patients are r and omly assigned to one of the three arms . The intervention lasts for six months . Pharmacy refill data of all patients are available from 11 months before , until 11 months after the start of the intervention . Primary outcome measure is adherence to oral antidiabetics calculated from : 1 ) data collected with  RTMM  , as a percentage of medication taken as prescribed , and as percentage of medication taken within the correct time interval , 2 ) refill data , taking the number of days for which oral antidiabetics are dispensed during the study period divided by the total number of days of the study period . Differences in adherence between the intervention groups and control group are studied using refill data . Differences in adherence between the two intervention groups are studied using RTMM data . Discussion The intervention described in this article consists of providing RTMM to patients with suboptimal adherence levels . This system combines real time monitoring of medication use with SMS reminders if medication is forgotten . If RTMM proves to be effective , it can be considered for use in various patient population s to support patients with their medication use and improve their adherence . Trial registration Netherl and s Trial Register Russell C , Conn V , Ashbaugh C , Madsen R , Wakefield M , Webb A , Coffey D , Peace L. Taking immunosuppressive medications effectively ( TIMELink ) : a pilot r and omized controlled trial in adult kidney transplant recipients . Clin Transplant 2011 : 25 : 864–870 . © 2010 John Wiley & Sons This pilot study aim ed to examine the effectiveness of  visual-feedback therapy  for individuals with psychotic disorders .  Visual-feedback therapy combines structured psychodynamic therapy and visual feedback achieved via an electronic monitoring medication cap to increase insight about medication behaviours . Thirty subjects were r and omly assigned either to visual feedback or to a supportive counselling group .  Medication adherence was measured by both electronic monitoring and blood plasma drug concentration levels . The results showed that , at the end of the 3-month , intervention ( bimonthly sessions ) , adherence rates of the visual-feedback group slightly increased , but declined during the course of the study for the supportive counselling control group ( P=0.026 ) Background / Aims . One of the causes of uncontrolled secondary hyperparathyroidism ( sHPT ) is patient 's poor drug adherence . We evaluated the clinical benefits of an integrated care approach on the control of sHPT by cinacalcet . Methods . Prospect i ve , r and omized , controlled , multicenter , open-label study . Fifty hemodialysis patients on a stable dose of cinacalcet were r and omized to an  integrated care approach ( IC ) or usual care approach ( UC ) . In the IC group , cinacalcet adherence was monitored using an electronic system . Results were discussed with the patients in motivational interviews , and drug prescription adapted accordingly . In the UC group , drug adherence was monitored , but results were not available . Results . At six months , 84 % of patients in the IC group achieved recommended iPTH targets versus 55 % in the UC group ( P = 0.04 ) . The mean cinacalcet taking adherence improved by 10.8 % in the IC group and declined by 5.3 % in the UC group ( P = 0.02 ) . Concomitantly , the mean dose of cinacalcet was reduced by 7.2 mg/day in the IC group and increased by 6.4 mg/day in the UC group ( P = 0.03 ) . Conclusions . The use of a drug adherence monitoring program in the management of sHPT in hemodialysis patients receiving cinacalcet improves drug adherence and iPTH control and allows a reduction in the dose of cinacalcet PURPOSE To investigate the impact of an intervention program to improve adherence with topical , once daily therapy for glaucoma . DESIGN R and omized controlled clinical trial . PARTICIPANTS Sixty-six patients with glaucoma being treated with a prostagl and in analog in 1 or both eyes at the Scheie Eye Institute or Wilmer Eye Institute between November 2006 and June 2007 . METHODS In an observational study , participants who took 75 % or fewer doses ( as measured using the travoprost Dosing Aid [ DA ] ) during an initial 3-month period were r and omized into 2 groups . The intervention group watched an educational video , review ed current barriers to drop-taking and possible solutions with a study coordinator , received regular phone call reminders , and had audible and visible reminders activated on their DA devices . The control group was told to take drops as prescribed and received no additional intervention . MAIN OUTCOME MEASURES Change in drop use adherence as determined by the DA device . RESULTS In the 3-month observation period before r and omization , intervention group patients had used a mean of 54+/-17 % of scheduled doses , and this increased to 73+/-22 % during the following 3-month period ( P<0.001 , n = 35 ) . The control mean adherence rate of 46+/-23 % at baseline was statistically unchanged during the follow-up observation period ( 51+/-30 % , P = 0.16 , n = 31 ) . In a multivariate analysis , intervention , baseline compliance rate of < 50 % , and white ethnicity were predictors of improved adherence during the 3 months of intervention . The intraocular pressure ( IOP ) of the intervention and control groups did not change between months 3 and 6 after intervention ( P = 0.96 , 0.34 , respectively ) , and there was no correlation of IOP change with adherence rate change between both groups ( Pearson correlation r = 0.06 , P = 0.51 ) . CONCLUSIONS A multifaceted intervention significantly increased adherence with glaucoma medications . Those with improved adherence were in the intervention group , had very low adherence rates at baseline , and were white . IOP did not correlate with adherence . Further research is needed to determine which components of this intervention were most effective A two-group r and omized experimental design was employed to assess the effects of monitoring and feedback on the compliance of 93 psychiatric out patients treated with lithium . Compliance in both groups was measured using self-report , lithium level , appointment-keeping , and medication refill frequency . The experimental group was also monitored using a unique electronic device 
    Output:
    
Devices integrated into the care delivery system and design ed to record dosing events are most frequently associated with improved adherence , compared with other devices .