Determining the feasibility of objective adherence measurement with blister packaging smart technology

PURPOSE

The results of a feasibility study of blister-pack smart technology for monitoring medication adherence are reported.

METHODS

Research in the area of objective therapy compliance measurement has led to the development of microprocessor-driven systems that record the time a unit dose is removed from blister packaging. One device under development is the Smart Blister-a label imprinted with event-detection circuitry that can be affixed to standard commercial blister cards. In the first trial of the device in actual clinical practice, 115 community-dwelling Dutch patients receiving valsartan maintenance therapy (160 mg once daily) were given 14-day blister packages equipped with the Smart Blister. On the return of empty blister cards to the 20 participating community pharmacies, the stored information was scanned and downloaded for data analysis and patient counseling purposes.

RESULTS

A total of 245 Smart Blister-equipped packages were used by valsartan recipients during the eight-month study. The device was largely effective in recording patient and blister-card identification data and other desired information. However, in 17% of cases, the Smart Blister system registered multiple tablet-removal events at the same time, presumably indicating unintentional breakage of nearby conductive circuits and the need for design refinements. The Smart Blister-equipped medication cards were generally well received by patients and pharmacies.

CONCLUSION

An evaluation of the functionality and robustness of the Smart Blister in a real-world clinical practice situation yielded some promising results, but the findings also indicated a need for design refinements and additional performance testing of the device.

The effect of sublingual captopril versus intravenous enalaprilat on angiotensin II plasma levels

A 44-year-old woman, with a history of familial adenomatous polyposis, complicated by carcinoma of the colon, for which a proctocolectomy had been performed, now presented with metastasis located in the pancreas. Treatment consisted of chemotherapy followed by a partial pancreaticoduodenectomy. Due to ischemia, resection of the small intestines was performed the same day. After admission, a transesophageal echocardiography showed an ejection fraction of 40%. Because enteral administration of drugs was impossible, intravenous enalaprilat 2 mg once a day for 1 day followed by sublingual captopril 25 mg twice a day were started. Blood samples were taken before and after administration. After 1 day of sublingual captopril treatment the angiotensin II level decreased with more than 50%, comparable to the decrease seen after intravenous administration of enalaprilat. Sublingual captopril has been used in the treatment of hypertensive crisis and heart failure. Although frequently reported, no study has investigated the effect on angiotensin II levels after sublingual administration in heart failure patients. This case-report demonstrated that sublingual administration of 25 mg captopril twice a day yielded a considerable decrease in angiotensin II plasma levels which was comparable to the effect seen after an intravenous administration of 2 mg enalaprilat.