Electronic monitoring of medication adherence: When is high-tech best?

The accurate measurement of medication adherence is challenging, particularly in pediatrics. Electronic monitoring has been proposed as a possible "gold standard" for medication adherence measurement. Electronic monitoring permits the evaluation of patterns of medication use and dose-response relationship and may be a useful part of adherence promotion interventions. The use of these devices, however, is not without costs and cautions including, expense, malfunctioning, and interference with existing adherence routines. This review examines the costs and benefits of using electronic monitoring of adherence as well as the reliability and validity of electronic monitoring in general and, where possible, for specific devices (i.e., MEMS, MDIlog, and Doser). Finally, we provide recommendations for quality control protocols to minimize many of the problems encountered when using such devices. Ultimately, the choice of adherence measurement strategy should be based on the goal of the study and the resources available.