Objectives. Suboptimal medication adherence is a serious problem in the treatment of chronic inflammatory diseases. To measure medication adherence, electronic monitoring is regarded as superior to... Show moreObjectives. Suboptimal medication adherence is a serious problem in the treatment of chronic inflammatory diseases. To measure medication adherence, electronic monitoring is regarded as superior to pill count. GLORIA is an ongoing two-year trial on the addition of low-dose (5 mg/d) prednisolone or placebo to standard care in older people (65+ years) with RA. During the entire trial, adherence is measured with electronic caps, and with pill counts. The objective is to describe medication adherence patterns, and to compare the adherence results of the two methods.Methods. The recorded adherence patterns of patients (blinded for treatment group) were classified according to descriptive categories. The cutoff for good adherence was set at 80% of prescribed pills taken.Results. Trial inclusion closed in 2018 at 451 patients, but trial follow-up is ongoing; the current dataset contains adherence data of 371 patients. Mean number of recorded 90-day periods per patient was 4 (range 1-8). Based on pill count over all periods, 90% of the patients had good adherence; based on cap data, only 20%. Cap data classified 30% of patients as non-user (<20% of days an opening) and 40% as irregular user (different adherence patterns, in or between periods).Conclusion. In our trial of older people with RA, the majority appeared to be adherent to medication according to pill count. Results from caps conflicted with those of pill counts, with patterns suggesting patients did not use the bottle for daily dispensing, despite specific advice to do so. Show less
This contribution describes the way electronic monitoring (EM) is organized and implemented in the Netherlands. It will become clear that the situation in the Netherlands is characterized by, in... Show moreThis contribution describes the way electronic monitoring (EM) is organized and implemented in the Netherlands. It will become clear that the situation in the Netherlands is characterized by, in particular, two features. The application of EM is highly interwoven with the Probation Service and its reintegrative objectives, a characteristic that dominates the organization and use of EM to a great extent. Paradoxically, EM is hardly used in the Netherlands as an autonomous (stand-alone) replacement for short prison sentences. The most straightforward explanation for this situation is that the Netherlands does not really need EM to replace prison capacity since its prison population already decreased drastically since 2005. A second explanation is that the intense involvement of the probation service in the enforcement of electronic monitoring has as a side-effect that these sanctions are not accepted as punitive sanctions, but fully framed into the rehabilitative perspective. Show less
