Use of the Medication Event Monitoring System to estimate medication compliance in patients with schizophrenia E Diaz, H Levine, et al Psychiatry Neurosci. 2001 September; 26(4): 325–329.

This admirably straightforward study focuses on the feasibility of and potential hurdles in using the Medication Event Monitoring System (MEMS) to monitor medication compliance in schizophrenic patients.

MEMS data were collected for a six month post-hospitalization period for fourteen patients taking antipsychotics.

Results

Patient medication compliance data were collected from 10 (71%) of 14 patients during the first month, from 7 (58%) of 12 (2 patients dropped out) during the second and from 5 (45%) of 11 (a third patient dropped out) during months 3–6. Mean compliance rates were 63% for the first month and ranged from 56% to 45% over the next 5. First-month compliance rates were significantly lower for those who were subsequently readmitted to hospital (n = 7) than for those who were not (p < 0.01). [Quote from abstract]

Commentary

While not an insurmountable finding, it is significant that seven patients of the fourteen from whom data was collected lost one 1 or more caps, each of which cost $126. Given that two patients dropped out in the first month and another dropped out in months 3-6, this is not a trivial occurrence.

This project does support the authors’ somewhat hedged conclusion,
“For many of these severely ill patients, we were able to estimate compliance with antipsychotic medication using a MEMS electronic monitor.” It is, however, fair to note that for a significant number, this was not a workable solution. And, given the dropout rate, the recommendations for “more frequent follow-ups in the immediate period after inpatient discharge” and paying a fee for patients to return the caps, and the observation that “clinicians needed to be reminded of the importance of MEMS use so they would continue to encourage the correct use of the cap,” it is evident that implementing MEMS to monitor compliance in schizophrenic patients falls short of being a simple turnkey operation. Instead, it appears that MEMS is a potentially valuable tool but one that requires specific skills and significant effort and attention to use.

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