due to seemingly inadequate response to the
prescribed drug regimens. If there is one lesson
taught by the past decade of research on patient
compliance, it is to put uppermost the question:
nonresponder or non-complier? The economic
opportunities for value-added packaging are to be
found in our growing understanding of the medical
and economic advantages of correctly answering
this basic question in situations where the wrong
answer is verycostly in both medical and economic
terms.
27.18 Conclusion
Almost two decades ago, the problem was how
to measure drug intake in ambulatory patients
(Averbuchet al., 1990; Kruse and Weber, 1990).
That problem has been solved by a variety of
approaches which integrate time stamping, record-
ing microcircuitryintoavarietyofdrugpackages, to
recordtimeswhen the packageisusedinthe manner
needed to provide a dose of drug for the patient.
Electronic monitoring is, to be sure, an indirect
method of measuring drug intake by ambulatory
patients, in that it does not show actual ingestion
of the dose but has the unique virtue of being a
method that does not require the patient to do any-
thing exceptional and that provides continuity of
data flow over long periods of time, and has proved
itself in a variety of settings to be the superior
method of measurement (Wagnet, 2002). Naturally,
it must be used with common sense, for it does have
certain ‘blind spots’ that can occur if, for example,
the patient removes doses at times remote from
actual ingestion, or if the patient uses a second,
non-monitored package for one reason or another.
However, these are errors made mainly by patients
whoarestrivingforfullcompliance,nottheerrorsof
the negligent, who often seek to minimize the errors
they make. Thus, if one includes some appropriate
questioning of the patient, these ‘blind spots’ can be
identified and avoided.
The key question facing us today is how best to
target the methods now in hand, so that they
improve care and reduce costs. Some suggestions
to that end are provided above (World Health
Organization, 2004).
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