title: Improving medication adherence in diabetes type 2 patients through Real Time Medication Monitoring: a randomised controlled trial to evaluate the effect of monitoring patients' medication use combined with short message service (SMS) reminders.
abstract: 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 aimed at evaluating the effect of RTMM on adherence to oral antidiabetics.
  
  
  METHODS
  Randomised 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 randomly 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.
  
  
  CONCLUSIONS
  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 populations to support patients with their medication use and improve their adherence.
  
  
  BACKGROUND
  Netherlands Trial Register NTR1882.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands. m.vervloet@nivel.nl
authors.forename: Marcia
authors.initials: M
authors.lastname: Vervloet
authors.forename: Liset
authors.initials: L
authors.lastname: van Dijk
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Santen-Reestman
authors.forename: Bas
authors.initials: B
authors.lastname: van Vlijmen
authors.forename: Marcel L
authors.initials: ML
authors.lastname: Bouvy
authors.forename: Dinny H
authors.initials: DH
authors.lastname: de Bakker
mesh_terms: D000284:Administration, Oral; D003199:Computer Systems; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D010349:Patient Compliance; D017010:Reminder Systems
chemical_list: D007004:Hypoglycemic Agents