Table 1.

Diagnostic methods to measure MNA; definition, advantages and disadvantages of direct and indirect methods for diagnosis of MNA

Methods	Definition	Advantages	Disadvantages
Direct
Directly observed therapy	Sightly supervised drug administration by healthcare personnel or caregiver	High reliability	Expensive Time-consuming Loss of independence
Wireless observed therapy [23]	Ingestible sensor system embedded in pills.	High reliability	Expensive Gastrointestinal discomfort Skin reaction to ingestion detector
Therapeutic drug monitoring [15, 27, 24–35]	Investigate the discrepancies between expected and observed drug blood levels.	Easily available at every transplant centre	Not available for every drug Reflect a short interval of time
Indirect
Pill counts [36]	Healthcare personnel, caregivers and pharmacists can count pill and monitor drug refills	Inexpensive	Patients can hide pills Requires a single distribution system Time-consuming
Electronic monitoring [37–42]	Use of microprocessors embedded in the medication container		Do not assure drug ingestion Uncomfortable device Expensive
Self-reported questionnaire [14, 43, 44]	Questions to determine whether and how often the patients did not correctly take the prescribed medication	Easy, inexpensive and can be done during routine visits	Can underestimate intentional MNA