Survey of patient and physician assessment of a compliance reminder device in the treatment of hypertension.

Low compliance to therapeutic regimens can have serious impact on patient health. A variety of technologies such as tablet dispensers and reminders has been developed to improve compliance. The aim of this study was to assess the acceptance of patients and physicians with regard to the functions and usefulness of a reminder device. The respondents were participants in a trial evaluating antihypertensive medical treatment. Patients and treating physicians received a self-administered questionnaire to evaluate the device; 1194 patients and their physicians completed the questionnaire. Seventy-three per cent of patients stated that they always or mostly used the device. Overall, 78% of patients and 83% of physicians assessed the device positively. The reminder and feedback functions were assessed similarly. Sixty-four per cent of the patients stated that they would like to continue to use the device, as did 71% of the physicians. The reminder device was well accepted by a majority of patients and physicians in this study. Acceptance is an important factor for such a device to be used in everyday life and a majority of respondents wanted to continue using it. The current device could be a major help for patients on chronic medication therapy in a variety of therapies.

Diurnal differences in melatonin effect on intracellular Ca2+ concentration in chicken spleen leukocytes in vitro.

Melatonin plays a pleiotropic role in the immune system of mammals and birds. Endogenous and exogenous melatonin modulates lymphocyte proliferation via specific MT(1), MT(2) and Mel(1c) membrane receptors, although the mechanisms behind this process are poorly understood. The diurnal changes in the expression and function of melatonin membrane receptors within the immune system have so far received little attention. We investigated the day/night differences in melatonin membrane receptor mRNA expression in chicken lymphoid organs and cultured splenocytes and examined the in vitro effect of melatonin and 2-iodomelatonin on the intracellular Ca(2+) concentration ([Ca(2+)](i)) in chicken splenocytes. In whole organs, expression of all subtypes of Mel membrane receptors was observed, and the level did not change significantly with the time of day. Interestingly, we observed a significant increase in the expression of the transcripts of all receptor subtypes in cultured splenocytes isolated at night compared with cells obtained during the day. In chicken spleen leukocytes isolated during the day, melatonin and 2-iodomelatonin increased [Ca(2+)](i), with only 2-iodomelatonin being effective in the 'night' cells. Luzindole modulated the [Ca(2+)](i) increase caused by melatonin receptor agonists: it potentiated the stimulatory effect of melatonin during the day, but counteracted that evoked by 2-iodomelatonin at night. The results of this study demonstrate that melatonin can induce changes in [Ca(2+)](i) in chicken spleen leukocytes that should modulate proliferation. The effect of melatonin on [Ca(2+)](i) is less pronounced at night, possibly caused by receptor desensitization.

The impact of an electronic monitoring and reminder device on patient compliance with antihypertensive therapy: a randomized controlled trial.

BACKGROUND: High blood pressure (BP) significantly increases overall cardiovascular risk, the incidence of ischemic heart disease and stroke. One of the most important causes of insufficient BP control is low treatment compliance. Reminders and electronic compliance monitoring have been shown to be effective in improving patient compliance to some extent, but the combined effect has not been documented. OBJECTIVE: To assess the impact of an electronic reminder and monitoring device on patient compliance and BP control. METHODS: All patients received medical treatment with telmisartan once daily and were randomized to either electronic compliance monitoring with a reminder and monitoring device or standard therapy for 6 months. Both groups were crossed over after 6 months. Intervention effectiveness was assessed using self-reported compliance and BP. RESULTS: Data from 398 patients were analysed. In the first half of the study, patients using the device reported 91% compliance versus 85% in the control group. This difference diminished after crossover (88 versus 86%). BP was not affected. Electronic monitoring data on compliance revealed taking, dosing and timing compliance between 45 and 52% in study group 1, and between 32 and 38% in study group 2. CONCLUSION: The Helping Hand reminder device was most suitable if used for newly diagnosed hypertensive patients, when it improved compliance by 6%. With the present medical treatment, the device does not have any influence on BP control, but with less forgiving medications, the device might make a significant difference. The use of the device can be an easy and effective way to improve compliance in selected patients.