***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: Abstract OBJECTIVE : Adherence to combination antiretroviral therapy  is critical for clinical and virologic success in HIV-infected patients . To combat poor adherence , clinicians must identify nonadherent patients so they can implement interventions . However , little is known about the accuracy of these assessment s. We sought to describe the accuracy of clinicians ’ estimates of patients ’ adherence to combination antiretroviral therapy . SETTING : Public HIV clinic . DESIGN : Prospect i ve cohort study . During visits , we asked clinicians ( nurse practitioners , residents and fellow , and their supervising attending physicians ) to estimate the percentage of antiretroviral medication taken by patients over the last 4 weeks and predicted adherence over the next 4 weeks .  Adherence was measured using  electronic monitoring devices , pill counts , and self-reports  , which were combined into a composite adherence measure . PATIENTS AND PARTICIPANTS : Clinicians estimated 464 episodes of adherence in 82 patients . RESULTS : Among the 464 adherence estimates , 264 ( 57 % ) were made by principal care providers ( 31 % by nurse practitioners , 15 % by fellows , 6 % by residents , and 5 % by staff physicians ) and 200 ( 43 % ) by supervising attending physicians . Clinicians ’ overestimated measured adherence by 8.9 % on average ( 86.2 % vs 77.3 % ) . Greater clinician inaccuracy in adherence prediction was independently associated with higher CD4 count nadir ( 1.8 % greater inaccuracy for every 100 CD4 cells , P=.005 ) , younger patient age ( 3.7 % greater inaccuracy for each decade of age , P=.02 ) , and visit number ( P=.02 ) . Sensitivity of detecting nonadherent patients was poor ( 24 % to 62 % , depending on nonadherence cutoff ) . The positive predictive value of identifying a patient as nonadherent was 76 % to 83 % . CONCLUSIONS : Clinicians tend to overestimate medication adherence , inadequately detect poor adherence , and may therefore miss important opportunities to intervene to improve antiretroviral adherence Recent studies suggest that involving pharmacists is an effective strategy for improving patient adherence and blood pressure ( BP ) control . To date , few controlled studies have tested the cost-effectiveness of specific models for improving patient adherence and BP control in community pharmacies , where most Americans obtain prescriptions . We hypothesized that a team model of adherence monitoring and intervention in corporately owned community pharmacies can improve patient adherence , prescribing , and BP control among hypertensive black patients . The Team Education and Adherence Monitoring ( TEAM ) Trial is a r and omized controlled trial testing a multistep intervention for improving adherence monitoring and intervention in 28 corporately owned community pharmacies . Patients in the 14 control pharmacies received " usual care , " and patients in the 14 intervention pharmacies received TEAM Care by trained pharmacists and pharmacy technicians working with patients and physicians .  Data collectors screened 1250 patients and enrolled 597 hypertensive black patients . The primary end points were the proportion of patients achieving BP control and reductions in systolic and diastolic BP measured after 6 and 12 months . Secondary end points were changes in adherence monitoring and intervention , patient adherence and barriers to adherence , prescribing , and cost-effectiveness . Research ers also will examine potential covariates and barriers to change . Involving pharmacists is a potentially powerful means of improving BP control  in blacks . Pharmacists are in an excellent position to monitor patients between clinic visits and to provide useful information to patients and physicians BACKGROUND Immunosuppression nonadherence increases the risk for kidney transplant loss after transplantation . Wireless-enabled pill bottles have created the opportunity to monitor medication adherence in real time . Reminders may help patients with poor memory or organization . Provision of adherence data to providers may motivate patients to improve adherence and help providers identify adherence barriers . STUDY DESIGN R and omized controlled trial . SETTING & PARTICIPANTS Kidney transplant recipients ( n=120 ) at a single center . INTERVENTION Participants were provided wireless pill bottles to store tacrolimus and record bottle openings . Participants were r and omly assigned 1:1:1 to adherence monitoring with customized reminders ( including alarms , texts , telephone calls , and /or e-mails ) , monitoring with customized reminders plus provider notification ( every 2 weeks , providers received notification if adherence decreased to < 90 % during that period ) , or wireless pill bottle use alone ( control ) . OUTCOMES The main outcome was bottle-measured tacrolimus adherence during the last 90 days of the 180-day trial . A secondary outcome was tacrolimus whole-blood concentrations at routine clinical visits . MEASUREMENTS Adherence for the primary outcome was assessed via wireless pill bottle openings . RESULTS Mean participant age was 50 years ; 60 % were men , and 40 % were black .  Mean adherence was 78 % , 88 % , and 55 % in the reminders , reminders-plus-notification , and control arms ( P<0.001 for comparison of each intervention to control ) . Mean tacrolimus levels were not significantly different between groups . LIMITATIONS The study did not assess clinical end points . Participants and study coordinators were not blinded to intervention arm . CONCLUSIONS Provider notification and customized reminders appear promising in helping patients achieve better medication adherence , but these strategies require evaluation in trials powered to detect differences in clinical outcomes Background Electronic monitoring is recommended for accurate measurement of medication adherence but a possible limitation is that it may influence adherence . Purpose To test the reactive effect of electronic monitoring in a r and omized controlled trial . Methods A total of 226 adults with type 2 diabetes and HbA1c ≥58 mmol/mol were r and omized to receiving their main oral glucose lowering medication in electronic containers or st and ard packaging . The primary outcomes were self-reported adherence measured with the MARS ( Medication Adherence Report Scale ; range 5–25 ) and HbA1c at 8 weeks . Results Non-significantly higher adherence and lower HbA1c were observed in the electronic container group ( differences in means , adjusting for baseline value : MARS , 0.4 [ 95 % CI −0.1 to 0.8 , p = 0.11 ] ; HbA1c ( mmol/mol ) , −1.02 [ −2.73 to 0.71 , p = 0.25 ] ) . Conclusions Electronic containers may lead to a small increase in adherence but this potential limitation is outweighed by their advantages . Our findings support electronic monitoring as the method of choice in research on medication adherence . ( Trial registration Current Controlled Trials IS RCT N30522359 Objective : Medication adherence is extremely important in preventing relapse and lowering symptoms in schizophrenic patients . However , estimates show that nearly half of these patients have poor adherence . The Brief Adherence Rating Scale ( BARS ) seems to be the most reliable tool assessing adherence in schizophrenia and shows that the antipsychotic adherence ratio ( AAR ) is about 49.5 % in schizophrenia . The aim of the study was to test if an electronic pill dispenser named DoPill ® improved AAR of schizophrenic patients . Furthermore , we compared AAR obtained by the DoPill ® and the BARS , in order to verify whether the DoPill ® provides reliable assessment of medication adherence . Methods : The DoPill ® is a smart pill dispenser that beeps and flashes at the appropriate time of the day . Each of its 28 compartments is covered by a plastic lamina that , when taken off , sends a signal to the pharmacist . Patients were r and omized to the DoPill ® or treatment as usual groups for 6 weeks . The BARS was used as a reference measure . Results : Forty-six percent of patients were deemed to be non-adherent with antipsychotic medication . The mean AAR was 67 % after 6 weeks . DoPill ® recorded better AAR than some of those found in the literature and were lower than the BARS estimate we found . Conclusion : These results suggest that DoPill ® is a valid tool that provides more reliable and objective data for the clinician about their patient ’s adherence , than existing assessment tools like the BARS . Furthermore , the device may help patients successfully manage their medication regimen CONTEXT In order for patients to benefit from a multidisciplinary treatment approach , diverse providers must communicate on patient care . OBJECTIVE We sought to examine the effect of information exchange across multidisciplinary human immunodeficiency virus ( HIV ) care providers on patient health outcomes . DESIGN R and omized controlled trial , r and omized at the patient level . SETTING Six infectious disease clinics paired with 9 ancillary care setting s ( eg , HIV case management ) . PARTICIPANTS Two hundred fifty-four patients with HIV receiving care at the infectious disease clinics . INTERVENTION Health information was exchanged for 2 years per patient between medical and ancillary care providers using electronic health records and printouts inserted into charts . Medical care providers gave ancillary care providers HIV viral loads , CD4 values , current medications , and appointment attendance . Ancillary care providers gave medical providers the information on medication adherence and major changes ( eg , loss of housing ) . MAIN OUTCOME MEASURES We abstract ed from medical records HIV viral loads , CD4 counts , and antiretroviral medication prescriptions before and during the intervention . From 0- , 12- , and 24-month patient surveys , we assessed hospitalizations , emergency department use , and health-related quality of life measured by the Medical Outcomes Study Short Form-36 ( SF-36 ) . RESULTS No statistically significant differences between cases and controls were found across time for the following : proportion with suppressed viral load , changes in viral load or CD4 values , patients being prescribed antiretroviral medication , hospitalizations , emergency department visits , or any scale of the SF-36 . Trends were mixed but leaned toward better health for control participants . CONCLUSIONS The exchange of this specific set of information between HIV medical and ancillary care providers was neutral on a variety of patient health outcomes Nonadherence to medication is a widespread problem in schizophrenia and is associated with poor clinical outcomes and inappropriate management and utilization of re sources . The aim of the current investigation was to assess the impact of telemonitoring of medication adherence on symptomatology and service use in patients with schizophrenia . A total of 108 schizophrenia patients were r and omized into three equal groups according to the approaches used to assess medication adherence ; self-report , pill counting , and telemonitoring . Telementoring was achieved through an innovative new platform called @HOME . This platform offers clinicians early warnings about impeding nonadherence as well as information about the pattern of medication taking . Patient 's adherence was observed over an 8-week period , during which patient 's clinical status and service use were recorded . In comparison to the other two groups , patients using @HOME showed improvement in the Global Clinical Impression Scale and a significant reduction in emergency visits and medical appointments . The @HOME platform was highly acceptable by patients , caregivers , and professionals , and required minimal training for implementation . The results of the study suggest that the use of telemonitoring in psychiatric setting s was both feasible and acceptable and may be associated with significant clinical and service related benefits OBJECTIVE To assess if the use of biological marker of bone resorption ( CTX ) feedback is a mean to improve persistence on monthly oral ib and ronate . METHODS One year prospect i ve multicenter study using a cluster r and omisation design with physicians as r and omized units into two groups , A and B ; in group B , physicians used results of CTX and two st and ardized messages according to CTX changes from baseline : suboptimal if decrease less than 30 % at week 6 , positive otherwise . In group A , the follow-up was st and ard of care . Patients were postmenopausal women , initiating a treatment with ib and ronate 150 mg monthly . They were blinded to the study hypotheses and outcome . The outcome was the proportion of patients persistent at 1-year visit . RESULTS Eighty-eight physicians were r and omized in group A and included 346 patients , 75 in group B included 250 patients . The persistence at 1-year was high and not different between the two groups ( 75.1 and 74.8 % P=0.932 ) . There was no difference in the proportion of persistent patients according to the message delivered in the group of patient with CTX information : 77.4 and 74.8 % in patients with a suboptimal or positive message respectively . CONCLUSION This study failed to demonstrate that supporting monitoring of CTX could improve persistence to ib and ronate treatment in postmenopausal osteoporosis . KEY MESSAGES Persistence is a strong determinant of anti-osteoporotic treatments efficacy . Monitoring of bone markers is not a mean to improve persistence of an oral bisphosphonate . There is a discrepancy between levels of persistence in clinical studies and real life This study investigates the impact of measuring adherence and providing feedback on medication usage by children with unstable asthma .  Adherence was measured using an electronic monitoring device . Subjects were r and omized to either being told of their adherence during review consultations or for their adherence to remain undisclosed to their parents and treating physician . 
    Output:
    
Across nine studies , we observed little or no evidence that provision of feedback to physicians regarding their patients adherence to prescribed medication improved medication adherence , patient outcomes , or health re source use .
Feedback about medication adherence may improve processes of care , but due to the small number of studies assessing this outcome and high risk of bias , we can not draw firm conclusions on the effect of feedback on this outcome .