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Chauhan N, Chakrabarti S, Grover S. Detecting medication non-adherence in schizophrenia: A comparison of different methods among outpatients from a North Indian center. Ind Psychiatry J 2023; 32:380-389. [PMID: 38161480 PMCID: PMC10756629 DOI: 10.4103/ipj.ipj_147_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 01/03/2024] Open
Abstract
Background The rates of medication non-adherence among Indian patients with schizophrenia are high, and its detection poses problems. Comparisons of suitable measures to detect medication non-adherence in schizophrenia from Indian outpatient settings are scarce. Aim This study compared simple and inexpensive methods of detecting medication non-adherence in schizophrenia among outpatients from a tertiary-care center in North India. Materials and Method A longitudinal comparison of two self-reports, the Morisky Medication Adherence Questionnaire and the Drug Attitude Inventory-10, clinicians' ratings employing the Compliance Rating Scale, and clinic-based pill counts was conducted among 70 outpatients with schizophrenia. The rates and detection of medication non-adherence, associations with determinants of treatment non-adherence, and agreement between measures were examined at intake and after six months of follow-up (n = 53). Results The self-reports had greater ability to detect medication adherence (specificity 41-65%; positive predictive values 25-51%; negative likelihood ratios 0.86-1.14) and moderate ability to detect medication non-adherence (sensitivity 27-65%; negative predictive values 49-69%; positive likelihood ratios 0.78-1.10). They yielded higher medication non-adherence rates, detected changes in medication non-adherence over time, and were associated with the other measures and the well-known correlates of medication non-adherence. Clinicians' ratings and pill counts had high sensitivity (56-90%) but low specificity (35-49%) to detect medication non-adherence. Conclusion Self-reports are comparatively better screening options for detecting medication non-adherence among Indian outpatients with schizophrenia. However, the sequential use of different measures could lead to better recognition of medication non-adherence.
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Affiliation(s)
- Nidhi Chauhan
- Department of Psychiatry, Postgraduate Institution of Medical Education and Research (PGIMER), Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institution of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institution of Medical Education and Research (PGIMER), Chandigarh, India
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2
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Velligan DI, Li F, Sebastian V, Kennedy C, Mintz J. A Pilot Study Examining Feasibility and Initial Efficacy of Remotely Delivered Cognitive Adaptation Training. SCHIZOPHRENIA BULLETIN OPEN 2023; 4:sgad028. [PMID: 37842080 PMCID: PMC10576524 DOI: 10.1093/schizbullopen/sgad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Cognitive Adaptation Training (CAT) is an evidence-based treatment that uses environmental supports including signs, text messages, checklists, smart pill containers, and the organization of belongings to bypass cognitive and motivational impairments and to cue adaptive behavior in the home or work environment. We developed and tested a remote version of CAT to make the treatment available more broadly. Because CAT is focused on working with the individual in their home environment to establish supports, CAT may not be as easy to translate into an effective virtual treatment as talk-therapies. Fifty-six members of managed care were assigned to or given their treatment preference for CAT or Remote CAT (R-CAT) for 6 months. In-person or virtual pill counts were conducted monthly and assessments of habit-formation, symptoms, functioning, and satisfaction were administered every 2 months by independent raters. Analyses using mixed models with repeated measures focused on pre-planned evaluations of within-group change. Adherence improved significantly in R-CAT, functioning improved significantly in CAT and both groups improved significantly on measures of habit-formation and symptoms across 6 months. Higher functioning individuals appeared to choose R-CAT. Satisfaction with treatment was very high in both groups. R-CAT appears to be a potentially effective treatment, particularly for medication follow-though. However, in contrast to decades of previous research, fewer than 20% of eligible Medicaid recipients agreed to participate in the study. This may have been due to recruitment during and immediately post-pandemic.
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Affiliation(s)
- Dawn I Velligan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, USA
| | - Feiyu Li
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, USA
| | - Veronica Sebastian
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, USA
| | - Cory Kennedy
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, USA
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, USA
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3
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Singh JA. SToRytelliing to Improve Disease outcomes in Gout (STRIDE-GO) in African American veterans with gout: a trial study protocol. Trials 2021; 22:879. [PMID: 34863255 PMCID: PMC8645140 DOI: 10.1186/s13063-021-05847-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 11/20/2021] [Indexed: 11/28/2022] Open
Abstract
Objective Medication adherence in gout is suboptimal, and the lack of effective interventions to address it presents a huge challenge. Medication adherence and gout outcomes are worse in racial/ethnic minorities. The objective of this paper was to provide the details of the study protocol for randomized, controlled trial (RCT) in African Americans (AAs) with gout that will test the effectiveness of a culturally appropriate gout storytelling intervention. Methods The SToRytelliing to Improve Disease outcomes in Gout (STRIDE-GO) study will be a 12-month, multicenter, open-label RCT that will assess the effect of a culturally appropriate gout storytelling in at least 300 AA veterans with gout. Participants will be randomized to gout-storytelling intervention vs. a stress reduction video in a 1:1 ratio. The primary outcome is urate-lowering therapy (ULT) adherence measured with MEMSCap™, an electronic monitoring system (efficacy, 6 months; sustenance of efficacy, 12 months). Secondary outcomes include gout flares, serum urate (SU), gout-specific health-related quality of life [HRQOL], self-reported ULT adherence, patient satisfaction with treatment, and patient understanding of the intervention. AA veterans with gout who met the 1977 Preliminary American College of Rheumatology (ACR) classification criteria for gout, currently prescribed an oral ULT medication (allopurinol or febuxostat) for at least 6 months, and not using a pillbox to redistribute their medications, will be invited to an in-person study visit. After the study coordinators obtain informed consent, and ensure that participants meet the inclusion criteria, the eligible participants will be provided with their current ULT in a MEMSCap™ bottle for the 1-month run-in period and asked to return to the clinic in 1 month. ULT adherence with MEMSCap™ will be recorded at a 1-month return visit. Interested participants will complete the baseline assessments, randomized using the computerized system to either gout-storytelling intervention or a stress reduction intervention video arm and watch the respective video in-clinic. Patients will be interviewed on the phone at 2 and 4 months regarding the viewing of the videos at home at each time. Participants will be assessed in-clinic at 3, 6, 9, and 12 months; MEMSCap™ data and patient surveys will be captured at each visit. For any missed visit, assessments will be completed on the phone and MEMSCap™ data captured at the next in-clinic visit. Discussion The study will assess the efficacy of a behavioral intervention to improve ULT adherence in minority populations with gout. Trial registration ClinicalTrials.gov NCT 02741700. Registered on 14 September 2018 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05847-9.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, VA Medical Center, 510, 20th street South, FOT 805B, Birmingham, AL, 35233, USA. .,Department of Medicine at School of Medicine, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA. .,Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL, 35294-0022, USA.
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4
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Hartman L, Cutolo M, Bos R, Opris-Belinski D, Kok MR, Griep-Wentink HJRM, Klaasen R, Allaart CF, Bruyn GAW, Raterman HG, Voshaar MJH, Gomes N, Pinto RMA, Klausch LT, Lems WF, Boers M. Medication adherence in older people with rheumatoid arthritis is lower according to electronic monitoring than according to pill count. Rheumatology (Oxford) 2021; 60:5239-5246. [PMID: 33682887 PMCID: PMC8566247 DOI: 10.1093/rheumatology/keab207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/14/2021] [Indexed: 12/11/2022] Open
Abstract
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 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. Trial registration NCT02585258. ClinicalTrials.gov (https://www.clinicaltrials.gov/)
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Affiliation(s)
- Linda Hartman
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Location VUmc.,Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Maurizio Cutolo
- Department of Rheumatology, University of Genoa, Genoa, Italy
| | - Reinhard Bos
- Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Daniela Opris-Belinski
- Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Marc R Kok
- Department of Rheumatology and Clinical immunology, Maasstad Hospital, Rotterdam
| | | | - Ruth Klaasen
- Department of Rheumatology, Meander Medical Center, Amersfoort
| | | | | | | | - Marieke J H Voshaar
- Department of Pharmacy, Radboud University, Nijmegen.,Tools Patient Empowerment, Amsterdam, The Netherlands
| | | | - Rui M A Pinto
- Bluepharma, Indústria Farmacêutica, S.A, Coimbra, Portugal
| | - L Thomas Klausch
- Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Willem F Lems
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Location VUmc
| | - M Boers
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Location VUmc.,Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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5
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Curto M, Fazio F, Ulivieri M, Navari S, Lionetto L, Baldessarini RJ. Improving adherence to pharmacological treatment for schizophrenia: a systematic assessment. Expert Opin Pharmacother 2021; 22:1143-1155. [PMID: 33543659 DOI: 10.1080/14656566.2021.1882996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Introduction: Poor adherence to pharmacological treatment is prevalent in schizophrenia, affecting more than half of patients at some time, with increased risks of clinical worsening, adverse outcomes, suicide, and increased resource utilization including hospitalization, with higher costs.Areas Covered: This review considers factors associated with treatment-nonadherence among schizophrenia patients, with a systematic evaluation of interventions aimed at improving adherence with an emphasis on evidence arising from their testing.Expert opinion: Several interventions have addressed factors empirically associated with treatment-nonadherence, including various drug-, patient - and clinical services-associated factors. They include long-acting injected (LAI) drug formulations, behavioral interventions, and technology-supported methods. Use of LAI antipsychotics and behavioral techniques aimed at incorporating medicine-taking into daily routines with electronic monitoring have been assessed relatively extensively. Mobile, digital applications including medication monitoring systems and artificial intelligence-based interactions are emerging but have been tested in few trials of limited quality with inconclusive results. Randomized, controlled, blinded trials based on clinically representative samples are needed to evaluate not only adherence, but also to test for clinically meaningful and sustained clinical benefits in schizophrenia patients, who are especially difficult to treat.
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Affiliation(s)
- Martina Curto
- Department of Mental Health, Rome, Italy.,International Consortium for Mood Psychotic & Mood Disorders Research, McLean Hospital, Belmont, MA, USA
| | - Francesco Fazio
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
| | - Martina Ulivieri
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
| | - Serena Navari
- Department of Mental Health, Colleferro (Rome), Italy
| | - Luana Lionetto
- Advanced Molecular Diagnostics Unit, Sant'Andrea Hospital, Rome, Italy
| | - Ross J Baldessarini
- International Consortium for Mood Psychotic & Mood Disorders Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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6
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Toscos T, Drouin M, Pater JA, Flanagan M, Wagner S, Coupe A, Ahmed R, Mirro MJ. Medication adherence for atrial fibrillation patients: triangulating measures from a smart pill bottle, e-prescribing software, and patient communication through the electronic health record. JAMIA Open 2020; 3:233-242. [PMID: 32734164 PMCID: PMC7382621 DOI: 10.1093/jamiaopen/ooaa007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/28/2020] [Accepted: 03/23/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Our primary objectives were to examine adherence rates across two technologies (e-prescribing software and smart pill bottle) with cross-validation from alert-triggered messaging within the patient electronic health record (EHR) portal and to explore the benefits and challenges faced by atrial fibrillation (AF) patients in using a smart pill bottle. MATERIALS AND METHODS We triangulated the rate of oral anticoagulant medication adherence among 160 AF patients over 6 months using an EHR in combination with data from the AdhereTech© Wireless Smart Pill Bottle and Surescripts©. In addition, we collected qualitative feedback on patients' Smart Pill Bottle usage through structured interviews with 153 participants. RESULTS Patients maintained an average adherence rate of 90.0% according to the smart pill bottle; however, when dose misses were calibrated based on patient or provider feedback, the adjusted adherence was 93.6%. Surescripts adherence rates for refills were 92.2%. Participants generally found the bottle easy to operate but suggested that its size and functionality did not fit seamlessly into their existing routine, as many used weekly pill organizers to manage multiple medications. DISCUSSION Though each method of tracking adherence has positive and negative attributes, combining them and seeking patient feedback may help capture a more accurate adherence rate than any single technological intervention. Technologies may have different design considerations for research and consumer use. CONCLUSION Overall, these technologies provide useful but imperfect adherence data for research purposes, and smart pill bottles could be improved with patient-centered design. LAY SUMMARY Medication adherence is very important for those with chronic health issues. For those with heart disease, medication adherence not only offers opportunities for improving quality of life, but it also can be life-saving. Nonetheless, many patients with heart disease, including those with atrial fibrillation (the target group for this study) do not take their medications regularly. As technologies advance, there is unprecedented opportunity to track patients' medication adherence through various methods, which might provide motivation and information to patients as they make daily choices about medication use. In this study, we cross-referenced the results of two of these measures over 6 months-a smart pill bottle, which we used to track pill bottle openings, and e-prescribing software, which we used to track medication refills. We also supplemented these measures with nurse-patient communication via the EHR messaging portal to record exceptions (eg, travel and medication changes) and interviewed patients about their medication use during the 6-month trial. Overall, the tracking technologies worked relatively well to track patient (n = 160) medication behavior; however, they did not capture exceptions. Hence, triangulating data from different sources, with a patient feedback loop, appears critical for gathering accurate data on medication adherence.
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Affiliation(s)
- Tammy Toscos
- Health Services and Informatics Research, Parkview Mirro Center for Research and Innovation, Fort Wayne, Indiana, USA
| | - Michelle Drouin
- Health Services and Informatics Research, Parkview Mirro Center for Research and Innovation, Fort Wayne, Indiana, USA
- Psychology Department, Purdue University Fort Wayne, Fort Wayne, Indiana, USA
| | - Jessica A Pater
- Health Services and Informatics Research, Parkview Mirro Center for Research and Innovation, Fort Wayne, Indiana, USA
| | - Mindy Flanagan
- Health Services and Informatics Research, Parkview Mirro Center for Research and Innovation, Fort Wayne, Indiana, USA
| | - Shauna Wagner
- Health Services and Informatics Research, Parkview Mirro Center for Research and Innovation, Fort Wayne, Indiana, USA
| | - Amanda Coupe
- Health Services and Informatics Research, Parkview Mirro Center for Research and Innovation, Fort Wayne, Indiana, USA
| | - Ryan Ahmed
- Health Services and Informatics Research, Parkview Mirro Center for Research and Innovation, Fort Wayne, Indiana, USA
| | - Michael J Mirro
- Health Services and Informatics Research, Parkview Mirro Center for Research and Innovation, Fort Wayne, Indiana, USA
- School of Informatics, Indiana University, Indianapolis, Indiana, USA
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7
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Yaegashi H, Kirino S, Remington G, Misawa F, Takeuchi H. Adherence to Oral Antipsychotics Measured by Electronic Adherence Monitoring in Schizophrenia: A Systematic Review and Meta-analysis. CNS Drugs 2020; 34:579-598. [PMID: 32219681 DOI: 10.1007/s40263-020-00713-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Poor adherence to oral antipsychotics is common in patients with schizophrenia; nonetheless, there has been no systematic review or meta-analysis on medication adherence measured by electronic adherence monitoring (EAM), considered by many as the 'gold standard' assessment. METHODS We systematically searched MEDLINE and Embase to identify studies investigating adherence to oral antipsychotics using EAM in patients with schizophrenia spectrum disorder. There were no exclusion criteria. We looked at the methodology in each study and defined which type of adherence was used in the study. Data on medication adherence, definition of satisfactory adherence (i.e., the threshold set in terms of the percentage of times medication was taken as prescribed), and factors associated with adherence were extracted for the included studies. Further, data on the rates of medication adherence were quantitatively synthesized. RESULTS A total of 19 studies involving 2184 patients were included. EAM-measured medication adherence was classified into three outcome types: taking adherence, regimen adherence, and timing adherence. The meta-analysis yielded oral antipsychotic adherence rates (defined as a continuous variable) of 71.1% for taking adherence [from seven studies, n = 256, 95% confidence interval (CI) 58.0-84.1], 70.0% for regimen adherence (from five studies, n = 174, 95% CI = 63.6-76.4), and 64.9% for timing adherence (from four studies, n = 212, 95% CI 53.2-76.6), respectively. The proportions of patients with oral antipsychotic adherence, when defined as a dichotomous variable, ranged from 50 to 78.3% for the 70% threshold for satisfactory adherence, 29.8-75.7% for the 75% threshold, and 47.8-75.7% for the 80% threshold. Factors associated with poor medication adherence were greater symptom severity, more frequent dosing regimen, poorer insight, and more negative drug attitude. CONCLUSIONS Oral antipsychotic adherence rates in schizophrenia, defined as a continuous variable and measured by EAM, were in the range of 70%, lower than the 80% threshold used widely to define satisfactory adherence.
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Affiliation(s)
| | - So Kirino
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Gary Remington
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Hiroyoshi Takeuchi
- Yamanashi Prefectural Kita Hospital, Yamanashi, Japan. .,Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. .,Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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8
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Getz K, Smith Z, Shafner L, Hanina A. Assessing the Scope and Predictors of Intentional Dose Non-adherence in Clinical Trials. Ther Innov Regul Sci 2020; 54:1330-1338. [PMID: 33258096 DOI: 10.1007/s43441-020-00155-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/18/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although there is broad agreement that the accurate estimation of non-adherence rates in clinical trials is essential to determining the dose-response relationship, treatment safety and efficacy effects, no accurate estimates have ever been produced. METHODS This study used a novel platform combining artificial intelligence and virtual patient monitoring to identify and quantify the scope of unreported intentional non-adherence in clinical trials of new medical therapies. Nearly 260,000 observations were drawn from a convenience sample of 2976 study volunteers participating in 23 clinical trials of psychiatric, neurological and neuromuscular diseases. RESULTS The results indicate that 4% of all confirmed doses were intentionally non-adherent, 48% of all study volunteers had at least one intentionally non-adherent dose and 5% of study volunteers were intentionally non-adherent for more than one-third of all doses required. CONCLUSIONS Several factors were associated with, and predictive of, unreported intentional non-adherence including clinical trial phase; clinical trial duration; geographic location where the study was conducted; and investigative site enrollment volume. The findings also show that although the overall rate of intentional non-adherence does not change over the course of a clinical trial, study volunteers who deliberately chose not to take their first dose had a mean intentional non-adherence rate five times higher than that observed among those who were first dose adherent. Implications of the study results are discussed.
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Affiliation(s)
- Kenneth Getz
- Tufts Center for the Study of Drug Development, Tufts University School of Medicine, 75 Kneeland Street, Suite 1100, Boston, MA, 02111, USA.
| | - Zachary Smith
- Tufts Center for the Study of Drug Development, Tufts University School of Medicine, 75 Kneeland Street, Suite 1100, Boston, MA, 02111, USA
| | - Laura Shafner
- AiCure, 19 West 24th Street, 11th Floor, New York, NY, 10010, USA
| | - Adam Hanina
- AiCure, 19 West 24th Street, 11th Floor, New York, NY, 10010, USA
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9
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Abstract
Outpatient diversion programs present an opportunity for severely mentally ill defendants to receive psychiatric treatment and have alleged offenses dismissed by the court. Moreover, the successful completion of pretrial diversion is associated with fewer post-program arrest and jail days. The target patient population for such programs is typically people with schizophrenia spectrum disorders, but the care of such patients in outpatient settings presents challenges for monitoring treatment fidelity, specifically antipsychotic adherence, as low adherence rates are associated with increased rates of recidivism. Presented here is a review of evidence-based strategies that must be employed to track antipsychotic adherence in outpatient diversion programs, including pill counts, use of long-acting injectable antipsychotics, and determination of plasma antipsychotic levels to assess adherence and the adequacy of antipsychotic treatment. Antipsychotic therapy remains the foundation of schizophrenia treatment, but only through the use of all available modalities can clinicians maximize the odds that schizophrenia patients in pretrial diversion maintain psychiatric stability and successfully complete mental health court mandates.
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10
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Barnes TR, Drake R, Paton C, Cooper SJ, Deakin B, Ferrier IN, Gregory CJ, Haddad PM, Howes OD, Jones I, Joyce EM, Lewis S, Lingford-Hughes A, MacCabe JH, Owens DC, Patel MX, Sinclair JM, Stone JM, Talbot PS, Upthegrove R, Wieck A, Yung AR. Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2020; 34:3-78. [PMID: 31829775 DOI: 10.1177/0269881119889296] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment. They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.
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Affiliation(s)
- Thomas Re Barnes
- Emeritus Professor of Clinical Psychiatry, Division of Psychiatry, Imperial College London, and Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Richard Drake
- Clinical Lead for Mental Health in Working Age Adults, Health Innovation Manchester, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Carol Paton
- Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Stephen J Cooper
- Emeritus Professor of Psychiatry, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Bill Deakin
- Professor of Psychiatry, Neuroscience & Psychiatry Unit, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - I Nicol Ferrier
- Emeritus Professor of Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine J Gregory
- Honorary Clinical Research Fellow, University of Manchester and Higher Trainee in Child and Adolescent Psychiatry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter M Haddad
- Honorary Professor of Psychiatry, Division of Psychology and Mental Health, University of Manchester, UK and Senior Consultant Psychiatrist, Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Oliver D Howes
- Professor of Molecular Psychiatry, Imperial College London and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian Jones
- Professor of Psychiatry and Director, National Centre of Mental Health, Cardiff University, Cardiff, UK
| | - Eileen M Joyce
- Professor of Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Shôn Lewis
- Professor of Adult Psychiatry, Faculty of Biology, Medicine and Health, The University of Manchester, UK, and Mental Health Academic Lead, Health Innovation Manchester, Manchester, UK
| | - Anne Lingford-Hughes
- Professor of Addiction Biology and Honorary Consultant Psychiatrist, Imperial College London and Central North West London NHS Foundation Trust, London, UK
| | - James H MacCabe
- Professor of Epidemiology and Therapeutics, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Honorary Consultant Psychiatrist, National Psychosis Service, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - David Cunningham Owens
- Professor of Clinical Psychiatry, University of Edinburgh. Honorary Consultant Psychiatrist, Royal Edinburgh Hospital, Edinburgh, UK
| | - Maxine X Patel
- Honorary Clinical Senior Lecturer, King's College London, Institute of Psychiatry, Psychology and Neuroscience and Consultant Psychiatrist, Oxleas NHS Foundation Trust, London, UK
| | - Julia Ma Sinclair
- Professor of Addiction Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James M Stone
- Clinical Senior Lecturer and Honorary Consultant Psychiatrist, King's College London, Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley NHS Trust, London, UK
| | - Peter S Talbot
- Senior Lecturer and Honorary Consultant Psychiatrist, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rachel Upthegrove
- Professor of Psychiatry and Youth Mental Health, University of Birmingham and Consultant Psychiatrist, Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angelika Wieck
- Honorary Consultant in Perinatal Psychiatry, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison R Yung
- Professor of Psychiatry, University of Manchester, School of Health Sciences, Manchester, UK and Centre for Youth Mental Health, University of Melbourne, Australia, and Honorary Consultant Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Kurokawa S, Kishimoto T, Su KP, Chang JPC, Chang HC, Yu X, Rodrigues-Silva N, Nielsen J, Unadkat A, Castle D, Haddad PM, Rocha D, Gadelha A, Kaliora S, Petrides G, Agid O, Tazawa Y, Takamiya A, Horigome T, Kane JM. Psychiatrists' perceptions of medication adherence among patients with schizophrenia: An international survey. Schizophr Res 2019; 211:105-107. [PMID: 31371039 DOI: 10.1016/j.schres.2019.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/09/2019] [Accepted: 07/21/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Shunya Kurokawa
- Department of Psychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Taishiro Kishimoto
- Department of Psychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 75-59 263rd Street Glen Oaks, New York 11004-1150, United States.
| | - Kuan-Pin Su
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, No.91 Hsueh-Shih Road, Taichung, 40402, Taiwan
| | - Jane Pei-Chen Chang
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, No.91 Hsueh-Shih Road, Taichung, 40402, Taiwan
| | - Hui-Chih Chang
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, No.91 Hsueh-Shih Road, Taichung, 40402, Taiwan
| | - Xin Yu
- Peking University Sixth Hospital, No.51 Hua Yuan Bei Road, Haidian District, Beijing, 100191, China
| | - Nuno Rodrigues-Silva
- Department of Psychiatry and Mental Health, Cova da Beira University Healthcare Center, Quinta do Alvito, Covilhã, 6200-251, Portugal
| | - Jimmi Nielsen
- Mental health Centre Glostrup, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Anish Unadkat
- The University of Melbourne and St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Melbourne, 3065, Australia
| | - David Castle
- The University of Melbourne and St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Melbourne, 3065, Australia
| | - Peter M Haddad
- Department of Psychiatry, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Deyvis Rocha
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), 650 - 3° andar, São Paulo 04039-032, Brazil
| | - Ary Gadelha
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), 650 - 3° andar, São Paulo 04039-032, Brazil
| | - Styliani Kaliora
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 75-59 263rd Street Glen Oaks, New York 11004-1150, United States
| | - Georgios Petrides
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 75-59 263rd Street Glen Oaks, New York 11004-1150, United States
| | - Ofer Agid
- Schizophrenia Program, Centre for Addiction and Mental Health (CAMH), Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College Street, CS 732, Toronto, ON M5T 1R8, Canada
| | - Yuki Tazawa
- Department of Psychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Akihiro Takamiya
- Department of Psychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Toshiro Horigome
- Department of Psychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - John M Kane
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 75-59 263rd Street Glen Oaks, New York 11004-1150, United States
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12
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Steinkamp JM, Goldblatt N, Borodovsky JT, LaVertu A, Kronish IM, Marsch LA, Schuman-Olivier Z. Technological Interventions for Medication Adherence in Adult Mental Health and Substance Use Disorders: A Systematic Review. JMIR Ment Health 2019; 6:e12493. [PMID: 30860493 PMCID: PMC6434404 DOI: 10.2196/12493] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/13/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Medication adherence is critical to the effectiveness of psychopharmacologic therapy. Psychiatric disorders present special adherence considerations, notably an altered capacity for decision making and the increased street value of controlled substances. A wide range of interventions designed to improve adherence in mental health and substance use disorders have been studied; recently, many have incorporated information technology (eg, mobile phone apps, electronic pill dispensers, and telehealth). Many intervention components have been studied across different disorders. Furthermore, many interventions incorporate multiple components, making it difficult to evaluate the effect of individual components in isolation. OBJECTIVE The aim of this study was to conduct a systematic scoping review to develop a literature-driven, transdiagnostic taxonomic framework of technology-based medication adherence intervention and measurement components used in mental health and substance use disorders. METHODS This review was conducted based on a published protocol (PROSPERO: CRD42018067902) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. We searched 7 electronic databases: MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science, Engineering Village, and ClinicalTrials.gov from January 2000 to September 2018. Overall, 2 reviewers independently conducted title and abstract screens, full-text screens, and data extraction. We included all studies that evaluate populations or individuals with a mental health or substance use disorder and contain at least 1 technology-delivered component (eg, website, mobile phone app, biosensor, or algorithm) designed to improve medication adherence or the measurement thereof. Given the wide variety of studied interventions, populations, and outcomes, we did not conduct a risk of bias assessment or quantitative meta-analysis. We developed a taxonomic framework for intervention classification and applied it to multicomponent interventions across mental health disorders. RESULTS The initial search identified 21,749 results; after screening, 127 included studies remained (Cohen kappa: 0.8, 95% CI 0.72-0.87). Major intervention component categories include reminders, support messages, social support engagement, care team contact capabilities, data feedback, psychoeducation, adherence-based psychotherapy, remote care delivery, secure medication storage, and contingency management. Adherence measurement components include self-reports, remote direct visualization, fully automated computer vision algorithms, biosensors, smart pill bottles, ingestible sensors, pill counts, and utilization measures. Intervention modalities include short messaging service, mobile phone apps, websites, and interactive voice response. We provide graphical representations of intervention component categories and an element-wise breakdown of multicomponent interventions. CONCLUSIONS Many technology-based medication adherence and monitoring interventions have been studied across psychiatric disease contexts. Interventions that are useful in one psychiatric disorder may be useful in other disorders, and further research is necessary to elucidate the specific effects of individual intervention components. Our framework is directly developed from the substance use disorder and mental health treatment literature and allows for transdiagnostic comparisons and an organized conceptual mapping of interventions.
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Affiliation(s)
| | - Nathaniel Goldblatt
- Outpatient Addiction Services, Department of Psychiatry, Cambridge Health Alliance, Somerville, MA, United States
| | | | - Amy LaVertu
- Tufts University School of Medicine, Boston, MA, United States
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York City, NY, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Zev Schuman-Olivier
- Outpatient Addiction Services, Department of Psychiatry, Cambridge Health Alliance, Somerville, MA, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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13
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Xu DR, Gong W, Gloyd S, Caine ED, Simoni J, Hughes JP, Xiao S, He W, Dai B, Lin M, Nie J, He H. Measuring adherence to antipsychotic medications for schizophrenia: Concordance and validity among a community sample in rural China. Schizophr Res 2018; 201:307-314. [PMID: 29807806 PMCID: PMC6252110 DOI: 10.1016/j.schres.2018.05.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 04/22/2018] [Accepted: 05/12/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Despite the abundance of measures to assess medication adherence by persons suffering schizophrenia, few studies have evaluated their concordance and validity against a reference standard in resource-poor community settings. We explored the concordance and validity of several measures to assess antipsychotic medication adherence in a resource-poor community. METHOD Based on a random sample of 278 villagers diagnosed with schizophrenia from Liuyang, Hunan Province, China, we used a concordance correlation coefficient (rc) and Kappa statistic to assess agreement among pill counts, refill records, clinician rating, Drug Attitude Inventory (DAI), and the Brief Adherence Rating Scale (BARS). The validity of various measures was evaluated by their concordance and sensitivity/specificity to home-based unannounced pill count (UPC) as the reference standard. RESULTS The estimated proportion of adherent patients according to all measures (41% ~ 88%) was substantially higher than identified by UPC (35%). Concordance between any two measures was poor (rc/Kappa mostly <0.30). Validity of various measures also was poor against the UPC (rc < 0.20; Kappa <0.16), although refill records and the structured instruments (BARS) performed better than office-based pill counts and clinician impression. BARS, DAI and clinician rating were not sensitive to changes in adherence and would likely underestimate any program effect. CONCLUSION In resource-poor community settings, most measures assessed in this study should not be used alone as they overestimated adherence, underestimated program effect, and had poor validity. A combination of UPC and several other measures may provide more insight into clinical trials and programmatic management.
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Affiliation(s)
- Dong Roman Xu
- Sun Yat-sen Global Health Institute (SGHI), School of Public Health and Institute of National Governance of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wenjie Gong
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
| | - Steve Gloyd
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Eric D Caine
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Jane Simoni
- Department of Phycology, University of Washington, Seattle, WA, USA
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Shuiyuan Xiao
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Wenjun He
- Department of Statistics, School of Public Health of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Bofeng Dai
- Department of Statistics, School of Public Health of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Meijuan Lin
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Juan Nie
- Sun Yat-sen Global Health Institute (SGHI), School of Public Health and Institute of National Governance of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hua He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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14
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Bright CE. Integrative Review of Mobile Phone Contacts and Medication Adherence in Severe Mental Illness. J Am Psychiatr Nurses Assoc 2018; 24:209-222. [PMID: 29457508 DOI: 10.1177/1078390318754986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Poor medication adherence is a significant problem in individuals with severe mental illness (SMI). About 50% of people with SMI become nonadherent to treatment in the first month following discharge from the hospital. OBJECTIVE This study examined literature in the past decade (2006-2016) on the use of mobile phone contacts in individuals with SMI to improve medication adherence post hospital discharge. DESIGN This integrative review used the search terms texting, text messaging, SMS, cell/mobile phone, medication adherence, medication compliance, and mental illness. Databases (CINAHL, PubMed, PsycINFO, and Scopus) and manual searching of reference lists were done. The main inclusion criteria were the use of mobile phone contacts on medication adherence in individuals with SMI. Adults 18 years and older, studies conducted from 2006 to 2016, and studies conducted in English were also criteria for inclusion. Only five studies met criteria for inclusion. RESULTS Outcomes from the review showed that mobile phone contacts have been used to improve medication adherence in individuals with SMI and able to provide the four types of social support (instrumental, informational, emotional, and, appraisal). When phone contacts especially text messaging was used as an adjunct to other interventions, it yielded better medication adherence than when used alone. However, results on medication adherence rates were mixed in participants on both psychiatric and nonpsychiatric medications. CONCLUSION Although mobile phone contacts are a promising tool to enhance medication adherence after hospital discharge, its effectiveness to increase medication adherence in this population remains inconclusive.
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Affiliation(s)
- Cordellia E Bright
- 1 Cordellia E. Bright, MHA, BSN, RN, PhD Candidate, Medical University of South Carolina, Charleston, SC, USA
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15
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Bright CE. Measuring Medication Adherence in Patients With Schizophrenia: An Integrative Review. Arch Psychiatr Nurs 2017; 31:99-110. [PMID: 28104068 DOI: 10.1016/j.apnu.2016.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/24/2016] [Accepted: 09/04/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this paper is to assess the validity, reliability and levels of evidence of existing instruments for measuring medication adherence in patients with schizophrenia. BACKGROUND Schizophrenia is estimated to affect approximately 7 individuals out of 1000 in their lifetimes, with fifty percent of patients attempting suicide. However studies have shown that measuring medication adherence in patients with schizophrenia is difficult and no gold standard currently exists. Without reliable and valid instruments to evaluate non-adherence in this population, research into strategies to improve adherence cannot move forward. DATA SOURCES This integrative review used the following search terms: assessing, measuring, medication adherence, schizophrenia, medication non-adherence, validity, reliability and measures. Databases searched included CINAHL, PubMed, PsycINFO and Scopus). Studies were included if they were published from 2000 to 2016. Fourteen instruments were identified from six studies and were included in this review. RESULTS All the instruments assessed were weak in both validity and reliability coupled with having low levels of evidence. Three instruments (two are fairly new) yielded better validity, reliability and sensitivity; however they have not been assessed in broad, diverse samples, so their generalizability remains unclear. CONCLUSION This study suggests the need to develop an instrument with adequate validity, reliability, and sensitivity to various patients' characteristics.
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Affiliation(s)
- Cordellia E Bright
- Medical University of South Carolina, College of Nursing, Charleston, SC.
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16
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Treisman GJ, Jayaram G, Margolis RL, Pearlson GD, Schmidt CW, Mihelish GL, Kennedy A, Howson A, Rasulnia M, Misiuta IE. Perspectives on the Use of eHealth in the Management of Patients With Schizophrenia. J Nerv Ment Dis 2016; 204:620-9. [PMID: 26828911 PMCID: PMC4972482 DOI: 10.1097/nmd.0000000000000471] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mobile devices, digital technologies, and web-based applications-known collectively as eHealth (electronic health)-could improve health care delivery for costly, chronic diseases such as schizophrenia. Pharmacologic and psychosocial therapies represent the primary treatment for individuals with schizophrenia; however, extensive resources are required to support adherence, facilitate continuity of care, and prevent relapse and its sequelae. This paper addresses the use of eHealth in the management of schizophrenia based on a roundtable discussion with a panel of experts, which included psychiatrists, a medical technology innovator, a mental health advocate, a family caregiver, a health policy maker, and a third-party payor. The expert panel discussed the uses, benefits, and limitations of emerging eHealth with the capability to integrate care and extend service accessibility, monitor patient status in real time, enhance medication adherence, and empower patients to take a more active role in managing their disease. In summary, to support this technological future, eHealth requires significant research regarding implementation, patient barriers, policy, and funding.
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Affiliation(s)
- Glenn J. Treisman
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Geetha Jayaram
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Russell L. Margolis
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Godfrey D. Pearlson
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Chester W. Schmidt
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Gary L. Mihelish
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Adrienne Kennedy
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Alexandra Howson
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Maziar Rasulnia
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Iwona E. Misiuta
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
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17
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Tarutani S, Kikuyama H, Ohta M, Kanazawa T, Okamura T, Yoneda H. Association between Medication Adherence and Duration of Outpatient Treatment in Patients with Schizophrenia. Psychiatry Investig 2016; 13:413-9. [PMID: 27482242 PMCID: PMC4965651 DOI: 10.4306/pi.2016.13.4.413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 12/28/2015] [Accepted: 12/31/2015] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Medication adherence is important in the treatment of schizophrenia, and critical periods during treatment may be associated with relapse. However, the relationship between adherence and duration of outpatient treatment (DOT) remains unclear. The authors aimed to clarify the relationship between adherence and DOT at a psychiatric hospital in Japan. METHODS For outpatients with schizophrenia who regularly visit Shin-Abuyama hospital, the authors conducted a single questionnaire survey (five questions covering gender, age, DOT, medication shortages, and residual medication) over one month period. Participants were divided into two groups whether DOT were from more than one year to within five years or not. Mantel-Haenszel analysis and logistic regression analysis were performed on the data regarding the medication adherence. RESULTS Effective answers were received for 328 patients. The residual medication rate was significantly higher among those receiving outpatient treatment from more than one year to within five years than five years than those receiving outpatient treatment for more than five years or less than one year (p=0.016). CONCLUSION This survey suggests that there are critical periods during which patients are most prone to poor adherence. Because poor adherence increases the risk of relapse, specific measures must be taken to improve adherence during these periods.
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Affiliation(s)
- Seiichiro Tarutani
- Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry, Osaka, Japan
- Department of Neuropsychiatry, Osaka Medical College, Osaka, Japan
| | - Hiroki Kikuyama
- Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry, Osaka, Japan
- Department of Neuropsychiatry, Osaka Medical College, Osaka, Japan
| | - Munehiro Ohta
- Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry, Osaka, Japan
| | - Tetsufumi Kanazawa
- Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry, Osaka, Japan
- Department of Neuropsychiatry, Osaka Medical College, Osaka, Japan
| | - Takehiko Okamura
- Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry, Osaka, Japan
| | - Hiroshi Yoneda
- Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry, Osaka, Japan
- Department of Neuropsychiatry, Osaka Medical College, Osaka, Japan
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18
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Tedla YG, Bautista LE. Drug Side Effect Symptoms and Adherence to Antihypertensive Medication. Am J Hypertens 2016; 29:772-9. [PMID: 26643686 PMCID: PMC5863783 DOI: 10.1093/ajh/hpv185] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 08/31/2015] [Accepted: 11/05/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Non-adherence to antihypertensive medication increases the risk of uncontrolled hypertension. Antihypertensive drug-related symptoms (side effects) are frequently cited as a main cause of non-adherence, but with little support from prospective studies. We evaluated the association between drug side effects and prospective adherence to treatment. METHODS We collected data on the number and dose of antihypertensive drugs at enrollment and at 3, 6, 9, and 12 months of follow-up in a cohort of 175 hypertensive patients starting or restarting antihypertensive treatment (mean age: 50 years; 58% women). During the follow-up visits, we gathered data on 24 side effects during the last month and the pill count adherence ratio (PCAR = pills taken out of number prescribed × 100) since the previous visit. The association between side effects at a visit and adherence through the next visit was estimated using mixed effect models. RESULTS Eighty-five percent of the participants experienced side effects, and 34.5% became non-adherent (PCAR <80%). After adjusting for confounders, PCAR was 6.0 percentage points lower (P = 0.04) among individuals with number of side effects above the median value (4 symptoms). Also, in individuals with genitourinary side effects, PCAR was 7.1 percentage points lower (P = 0.02) than in those without such side effects. Specifically, PCAR was 6.5 (P = 0.06) and 7.6 (P = 0.01) percentage points lower among individuals with excessive urination and decrease in sexual drive, respectively. CONCLUSION Antihypertensive drug side effects was associated with drug adherence but only excessive urination and decrease in sexual drive significantly predicted lower adherence. These symptoms could be used as markers to screen out patients at high risk of non-adherence.
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Affiliation(s)
- Yacob G Tedla
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA;
| | - Leonelo E Bautista
- Department of Population Health Sciences, University of Wisconsin at Madison, Madison, Wisconsin, USA
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19
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El Alili M, Vrijens B, Demonceau J, Evers SM, Hiligsmann M. A scoping review of studies comparing the medication event monitoring system (MEMS) with alternative methods for measuring medication adherence. Br J Clin Pharmacol 2016; 82:268-79. [PMID: 27005306 DOI: 10.1111/bcp.12942] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 12/31/2022] Open
Abstract
Different methods are available for measuring medication adherence. In this paper, we conducted a scoping review to identify and summarize evidence of all studies comparing the Medication Event Monitoring System (MEMS) with alternative methods for measuring medication adherence. A literature search was performed using the open database www.iAdherence.org that includes all original studies reporting findings from the MEMS. Papers comparing methods for measuring adherence to solid oral formulations were included. Data was extracted using a standardized extraction table. A total of 117 articles fulfilled the inclusion criteria, including 251 comparisons. Most frequent comparisons were against self-report (n = 119) and pill count (n = 59). Similar outcome measures were used in 210 comparisons (84%), among which 78 used dichotomous variables (adherent or not) and 132 used continuous measures (adherence expressed as percentage). Furthermore, 32% of all comparisons did not estimate adherence over the same coverage period and 44% of all comparisons did not use a statistical method or used a suboptimal one. Only eighty-seven (35%) comparisons had similar coverage periods, similar outcome measures and optimal statistical methods. Compared to MEMS, median adherence was grossly overestimated by 17% using self-report, by 8% using pill count and by 6% using rating. In conclusion, among all comparisons of MEMS versus alternative methods for measuring adherence, only a few used adequate comparisons in terms of outcome measures, coverage periods and statistical method. Researchers should therefore use stronger methodological frameworks when comparing measurement methods and be aware that non-electronic measures could lead to overestimation of medication adherence.
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Affiliation(s)
- Mohamed El Alili
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Bernard Vrijens
- WestRock Healthcare, Visé, Belgium.,Department of Public Health, University of Liège, Liège, Belgium
| | | | - Silvia M Evers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Trimbos Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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[Adherence to psychopharmacological treatment: Psychotherapeutic strategies to enhance adherence]. DER NERVENARZT 2016; 86:637-46; quiz 647-8. [PMID: 25903501 DOI: 10.1007/s00115-015-4275-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Effective psychopharmacological medication with good tolerability represents the cornerstone of treatment for severe mental illness; however, the 1-year adherence rates are only approximately 50%. The term adherence emphasizes the collaborative responsibility of the clinician and the patient for a positive treatment outcome. Reasons for non-adherence are manifold and include patient-specific factors, such as self-stigmatization, lack of social and familial support, cognitive impairment and substance use besides insufficient effectiveness and the occurrence of side effects of the psychotropic drugs. To enhance adherence, both clinician and patient have to fully understand all the reasons for and against adherence to medication before a collaborative decision is made on future long-term treatment. A positive attitude towards medication critically depends on whether patients feel that the medication supports the attainment of the individual goals.
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Okuyama Y, Oya K, Matsunaga S, Kishi T, Iwata N. Efficacy and tolerability of topiramate-augmentation therapy for schizophrenia: a systematic review and meta-analysis of randomized controlled trials. Neuropsychiatr Dis Treat 2016; 12:3221-3236. [PMID: 28008259 PMCID: PMC5170618 DOI: 10.2147/ndt.s125367] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This study aimed to perform a comprehensive meta-analysis of topiramate-augmentation therapy in patients with schizophrenia receiving antipsychotic agents. Data published up to June 20, 2016 were obtained from the PubMed, PsycINFO, and Cochrane Library databases. Twelve randomized controlled trials comparing topiramate to placebo or antipsychotic only were included (n=676 patients). The primary outcome was change in overall symptoms. Relative risk (RR) and standardized mean difference (SMD), along with 95% confidence intervals, were calculated using random effects model for each outcome. Topiramate-augmentation therapy was superior to the control for decreasing overall symptoms (SMD -0.55, 95% confidence interval -0.86 to -0.24; P=0.001; I2=55%, eight comparisons, n=380), positive symptoms (SMD -0.4), negative symptoms (SMD -0.47), and Positive and Negative Syndrome Scale general subscale scores (SMD -0.67). Furthermore, topiramate-augmentation therapy decreased weight (SMD -0.69) and body mass index (SMD -0.95) compared with the control. Topiramate was similar to the control with respect to discontinuation due to all causes (RR 1.19), inefficacy (RR 1.71), and adverse events (RR 1.09). Topiramate was associated with higher incidence of paresthesia (RR 2.67) and attention difficulty (RR 8.97) compared with the control. Our results seemed to suggest that topiramate-augmentation therapy improves the psychopathology of schizophrenia with good tolerability and has the additional advantage of weight maintenance. However, because there were some limitations (numbers of studies and patients included in the meta-analysis were small, some studies used completer analysis, Chinese studies were included in the meta-analysis, and studies that had a risk of bias were included in the meta-analysis) in this study, we cannot apply the results of this study in daily clinical practice.
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Affiliation(s)
- Yuji Okuyama
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kazuto Oya
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shinji Matsunaga
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
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Brain C, Sameby B, Allerby K, Quinlan P, Joas E, Lindström E, Burns T, Waern M. Stigma, discrimination and medication adherence in schizophrenia: results from the Swedish COAST study. Psychiatry Res 2014; 220:811-7. [PMID: 25457284 DOI: 10.1016/j.psychres.2014.10.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/22/2014] [Accepted: 10/12/2014] [Indexed: 11/29/2022]
Abstract
The aims of this naturalistic non-interventional study were to quantify the level of stigma and discrimination in persons with schizophrenia and to test for potential associations between different types of stigma and adherence to antipsychotics. Antipsychotic medication use was electronically monitored with a Medication Event Monitoring System (MEMS®) for 12 months in 111 outpatients with schizophrenia and schizophrenia-like psychosis (DSM-IV). Stigma was assessed at endpoint using the Discrimination and Stigma Scale (DISC). Single DISC items that were most frequently reported included social relationships in making/keeping friends (71%) and in the neighborhood (69%). About half of the patients experienced discrimination by their families, in intimate relationships, regarding employment and by mental health staff. Most patients (88%) wanted to conceal their mental health problems from others; 70% stated that anticipated discrimination resulted in avoidance of close personal relationships. Non-adherence (MEMS® adherence≤0.80) was observed in 30 (27.3%). When DISC subscale scores (SD) were entered in separate regression models, neither experienced nor anticipated stigma was associated with adherence. Our data do not support an association between stigma and non-adherence. Further studies in other settings are needed as experiences of stigma and levels of adherence and their potential associations might vary by a healthcare system or cultural and sociodemographic contexts.
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Haddad PM, Brain C, Scott J. Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies. Patient Relat Outcome Meas 2014; 5:43-62. [PMID: 25061342 PMCID: PMC4085309 DOI: 10.2147/prom.s42735] [Citation(s) in RCA: 340] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Nonadherence with medication occurs in all chronic medical disorders. It is a particular challenge in schizophrenia due to the illness's association with social isolation, stigma, and comorbid substance misuse, plus the effect of symptom domains on adherence, including positive and negative symptoms, lack of insight, depression, and cognitive impairment. Nonadherence lies on a spectrum, is often covert, and is underestimated by clinicians, but affects more than one third of patients with schizophrenia per annum. It increases the risk of relapse, rehospitalization, and self-harm, increases inpatient costs, and lowers quality of life. It results from multiple patient, clinician, illness, medication, and service factors, but a useful distinction is between intentional and unintentional nonadherence. There is no gold standard approach to the measurement of adherence as all methods have pros and cons. Interventions to improve adherence include psychoeducation and other psychosocial interventions, antipsychotic long-acting injections, electronic reminders, service-based interventions, and financial incentives. These overlap, all have some evidence of effectiveness, and the intervention adopted should be tailored to the individual. Psychosocial interventions that utilize combined approaches seem more effective than unidimensional approaches. There is increasing interest in electronic reminders and monitoring systems to enhance adherence, eg, Short Message Service text messaging and real-time medication monitoring linked to smart pill containers or an electronic ingestible event marker. Financial incentives to enhance antipsychotic adherence raise ethical issues, and their place in practice remains unclear. Simple pragmatic strategies to improve medication adherence include shared decision-making, regular assessment of adherence, simplification of the medication regimen, ensuring that treatment is effective and that side effects are managed, and promoting a positive therapeutic alliance and good communication between the clinician and patient. These elements remain essential for all patients, not least for the small minority where vulnerability and risk issue dictate that compulsory treatment is necessary to ensure adherence.
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Affiliation(s)
- Peter M Haddad
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK
- Greater Manchester West Mental Health NHS Foundation Trust, Salford, UK
| | - Cecilia Brain
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden
- Nå Ut-teamet, Psychosis Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, London, UK
- Centre for Affective Disorders, Institute of Psychiatry, London, UK
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