Electronic monitoring approaches should be more widely used

Editor—Giuffrida and Torgerson's paper focuses attention on a problem that is widely recognised but largely ignored—namely, compliance.1 Any measure that seeks to improve compliance with a prescribed regimen should be encouraged. As the authors concede in their introduction, however, the main challenge is identifying the patients whose compliance is considered to be inadequate.

Assessment of compliance should focus on the individual patient, and thus any approach that is targeted in a general manner at unselected populations is unlikely to be cost effective. The fundamental problem is that the prescribing clinician is unable to readily identify inadequate compliers and to distinguish them from poor responders or non-responders. This is not surprising as there is considerable evidence to indicate that compliance with a treatment regimen is not determined by age, sex, income, social status, level of educational achievement, or any other readily determinable factor. Thus before considering financial incentives to improve compliance we need to identify a reliable method to identify which patients to target.

It is now generally accepted that counts of returned tablets and patients' diaries are inadequate methods of assessing compliance and generally overestimate consumption of drugs.2 Measurement of drug concentrations in blood, urine, or saliva may provide a limited insight into compliance but is relatively expensive, not instantaneous, and often misleading as, for many drugs, improvement in compliance immediately before a clinic visit will mask a potential underlying problem.

Electronic …