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Jiang N, Jin W, Fu Z, Cao H, Zheng H, Wang Q, Zhang Q, Ju K, Wang J. Effects of Social Support on Medication Adherence Among Patients with Schizophrenia: Serial Multiple Mediation Model. Patient Prefer Adherence 2024; 18:947-955. [PMID: 38737488 PMCID: PMC11086644 DOI: 10.2147/ppa.s460210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose This study aims to explore the serial mediating effect of stigma and depression on the association between social support and medication adherence. Patients and Methods A cross-sectional survey was undertaken in the Changning District of Shanghai using a five-part questionnaire from August to December 2023. A convenient sampling method was employed, and 35 patients with schizophrenia were invited from each of the 9 streets in Changning District to participate in the survey, resulting in a total of 305 valid questionnaires collected. The questionnaire measured social support, stigma, depression, medication adherence, and demographic characteristics. Data analysis involved descriptive statistics, independent samples t-tests, ANOVA, Pearson correlation analysis, and the bootstrap method. Results There was a direct and significantly positive association between social support and medication adherence (β = 0.69, p < 0.001). Moreover, increased levels of stigma (β = - 0.45, p = 0.013) and depression (β = - 0.09, p = 0.017) were both associated with a decline in medication adherence. Bootstrapping analysis revealed that the association between social support and medication adherence operated indirectly through stigma (β = 0.11, 95% CI: 0.03, 0.18). Additionally, social support was indirectly associated with medication adherence through depression (β = 0.15, 95% CI: 0.04, 0.30). Further analysis indicated that social support had an indirect association with medication adherence through both stigma and depression (β = 0.04, 95% CI: 0.01, 0.07). Conclusion Stigma and depression serially mediate the association between social support and medication adherence among patients with schizophrenia. This serial multiple mediation model underscores the importance of integrating social support interventions with psychological interventions aimed at reducing stigma and depression, thereby effectively enhancing medication adherence in patients with schizophrenia.
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Affiliation(s)
- Nan Jiang
- Key Laboratory of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Wei Jin
- Department of Patriotic Public Health and Health Promotion instruction, Shanghai Municipal Center for Health Promotion, Shanghai, People’s Republic of China
| | - Zhenghui Fu
- Shanghai Changning Mental Health Center (Affiliated to East China Normal University), Shanghai, People’s Republic of China
| | - He Cao
- Key Laboratory of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Hong Zheng
- Shanghai Changning Mental Health Center (Affiliated to East China Normal University), Shanghai, People’s Republic of China
| | - Quqing Wang
- Key Laboratory of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Qiongting Zhang
- Shanghai Changning Mental Health Center (Affiliated to East China Normal University), Shanghai, People’s Republic of China
| | - Kang Ju
- Shanghai Changning Mental Health Center (Affiliated to East China Normal University), Shanghai, People’s Republic of China
| | - Jiwei Wang
- Key Laboratory of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, Shanghai, People’s Republic of China
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Medication Adherence to Psychotropic Medication and Relationship with Psychiatric Symptoms among Syrian Refugees in Turkey: A Pilot Study. TRAUMA CARE 2023. [DOI: 10.3390/traumacare3010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Background: Due to experiencing traumatic and stressful events, refugees are at risk of having mental disorders. The refugees might need to use psychotropic agents to treat mental disorders. It is essential to understand this population’s adherence rate to psychotropic medication. Aim: This study aimed to evaluate adherence to psychotropic medication and the relationship with psychiatric symptoms among Syrian refugees in Turkey. Method: The study design was descriptive and correlational. The study was conducted with 55 Syrian refugees attending a community health center in southern Turkey. The data was collected with General Medication Adherence Scale–Arabic Version (GMAS–AR) and Brief Psychiatric Inventory (BPI). Results: 78.2% (n: 43) of the participants’ medication adherence was poor, and a significant negative and weak correlation was found at 0.01 level between GMAS–AR and BPI (r: −0.37). According to multiple linear regression analysis, the model with gender and BPI was significant, and this model explained 19% of GMAS–AR total points (p < 0.001). Conclusion: Mental health professionals should test the effectiveness of psychosocial interventions that increase adherence to treatment for the cultural characteristics of societies.
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Summers J, Busch L, Kako M, Lau C. The role of the behavior analyst on interprofessional mental health teams: opportunities for collaboration and enhancing patient care. J Interprof Care 2021; 36:434-440. [PMID: 34514941 DOI: 10.1080/13561820.2021.1969345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Patients living with mental illness have needs that span a range of professional disciplines, settings, and service systems. These needs are best addressed through interprofessional collaboration. Behavior analysts can play a valuable role in enhancing patient care as part of the interprofessional mental health team. We provide information about the field of applied behavior analysis and its contribution to the assessment and treatment of patients living with mental health and substance use challenges. We outline how behavior analysts are trained and touch upon the practice of behavior analysis in North America and beyond. We describe collaborative relationships with other mental health professionals and, as an example, review the role of the behavior analyst on interprofessional teams in our mental health and addiction teaching hospital in Canada. We highlight some of the challenges faced by behavior analysts working in the mental health field and offer suggestions to increase their profile and opportunities for collaboration in clinical programs.
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Affiliation(s)
- Jane Summers
- Department of Psychiatry, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Louis Busch
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Milena Kako
- Launch Behavioural Health, Centre for Health Sciences, George Brown College, Toronto, ON, Canada
| | - Catherine Lau
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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Martin C, Koep E, White J, Belland A, Waters H, Forma F. Treatment Compliance Communications Between Patients with Severe Mental Illness and Treating Healthcare Providers: A Retrospective Study of Documentation Using Healthcare Reimbursement Claims and Medical Chart Abstraction. Pragmat Obs Res 2021; 12:49-63. [PMID: 34163283 PMCID: PMC8214573 DOI: 10.2147/por.s303453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Successful treatment for serious mental illnesses (SMIs) requires a good therapeutic alliance with healthcare providers and compliance with prescribed therapies such as antipsychotic medications. This retrospective study, which utilized administrative claims linked with abstracted medical chart data, addressed a data gap regarding compliance-related discussions between providers and patients. Methods Commercially insured patients in ambulatory care post-acute (emergency or inpatient) event were eligible. Criteria included age 18–65 years; schizophrenia, bipolar disorder, or major depressive disorder diagnoses; continuous enrollment 6 months before to 12 months after the first acute event claim dated 01/01/2014 to 12/31/2015; and antipsychotic medication prescription. Demographic and clinical data, and patient–provider discussions about treatment compliance were characterized from claims and abstracted medical charts. Results Ninety patients (62% female, mean age 41 years) were included and 680 visits were abstracted; only 58% had first-visit antipsychotic compliance discussions. Notably, 18% of patients had discussions using the specific terms “compliance,” “persistence,” or “adherence,” whereas half were identified by more general terms. Compliance discussions were observed least often among the patients with schizophrenia, as compared with bipolar or major depressive disorders—a counterintuitive finding. Discussion Compliance discussions may represent intervention opportunities to optimize treatment, yet their study is a complex endeavor. The results of this study show an opportunity to improve this valuable treatment step.
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Affiliation(s)
| | | | | | | | - Heidi Waters
- Policy Research Health Outcomes, Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | - Felicia Forma
- Otsuka Pharmaceutical Development & Commercialization, Inc., Health Economics and Outcomes Research, Princeton, NJ, USA
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Nguyen ML, Sunderland B, Lim S, Hattingh L, Chalmers L. A qualitative exploration of factors contributing to non-guideline adherent antipsychotic polypharmacy. Res Social Adm Pharm 2021; 18:2457-2467. [PMID: 33840621 DOI: 10.1016/j.sapharm.2021.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antipsychotic polypharmacy ("polypharmacy") involves the concurrent prescribing of two or more antipsychotics for managing schizophrenia. It occurs frequently despite there being limited clinical evidence for this practice and an increased risk of adverse events. Little is understood about why it occurs outside of treatment guidelines, highlighting a current research gap. OBJECTIVE To explore the factors contributing to non-evidence based polypharmacy practice and possible strategies for addressing these factors. METHODS Three focus groups were conducted between June and August 2018 with doctors and nurses employed at a mental health unit of a Western Australian public hospital. Participants were asked about their perceptions of polypharmacy, why it occurred and what could limit its prevalence. Thematic inductive analysis was mapped to the Theoretical Domains Framework to identify key underlying themes and to establish potential enablers and barriers for practice change. RESULTS Participants understood the risks of polypharmacy and perceived it to largely be perpetuated by external factors, out of which two key themes emerged: system-related issues (e.g.: communication failures whereby de-prescribing plans are not actioned); and patient-related issues (e.g.: misinformed views translating to medication-seeking behaviour). This led to the third theme: a disconnect between clinicians' knowledge and their practices (i.e.: being aware of Australian evidence-based guideline recommendations yet acknowledging polypharmacy still occurred due to the aforementioned issues). Strategies suggested to address these issues included developing medication management plans to bridge communication gaps and managing patients' medication expectations with education. CONCLUSIONS Management of schizophrenia is complex, requiring consideration of many patient-related and systemic factors. Polypharmacy has a place in certain contexts, however, must be well considered and closely monitored to allow for early identification of opportunities to rationalise (i.e.: de-prescribe) therapy, where appropriate. Future research objectives will centre on implementing strategies identified from these focus groups to optimise patient outcomes.
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Affiliation(s)
- My Linh Nguyen
- Curtin Medical School, Curtin University, Bentley, Western Australia, 6102, Australia; Pharmacy Department, Armadale Kalamunda Group, Mount Nasura, Western Australia, 6112, Australia.
| | - Bruce Sunderland
- Curtin Medical School, Curtin University, Bentley, Western Australia, 6102, Australia
| | - Stephen Lim
- Curtin Medical School, Curtin University, Bentley, Western Australia, 6102, Australia
| | - Laetitia Hattingh
- Curtin Medical School, Curtin University, Bentley, Western Australia, 6102, Australia; Gold Coast Health, Gold Coast, Queensland, 4215, Australia; School of Pharmacy and Pharmacology, Griffith University, Gold Coast, Queensland, 4222, Australia
| | - Leanne Chalmers
- Curtin Medical School, Curtin University, Bentley, Western Australia, 6102, Australia
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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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Sánchez J. Predicting Recovery in Individuals With Serious Mental Illness: Expanding the International Classification of Functioning, Disability, and Health (ICF) Framework. REHABILITATION COUNSELING BULLETIN 2020. [DOI: 10.1177/0034355220976835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
People with psychiatric disabilities experience significant impairment in fulfilling major life roles due to the severity of their mental illness. Recovery for people with serious mental illness (SMI) can be a long, arduous process, impacted by various biological, functional, sociological, and psychological factors which can present as barriers and/or facilitators. The purposes of this study were to: (a) investigate the International Classification of Functioning, Disability, and Health (ICF) framework’s ability to predict recovery in adults with SMI and (b) determine to what extent the ICF constructs in the empirical model explain the variance in recovery. Participants ( N = 192) completed a sociodemographic questionnaire and various measures representing all predictor and outcome variables. Results from hierarchical regression analysis with six sets of predictors entered sequentially (1 = personal factors-demographics, 2 = body functions-mental, 3 = activity-capacity, 4 = environmental factors, 5 = personal factors-characteristics, and 6 = participation-performance) accounted for 75% (large effect) of the variance in recovery. Controlling for all factors, by order of salience, higher levels of significant other support, education, executive function impairment, and social self-efficacy; primary, non-bipolar SMI diagnosis; greater resilience; lower levels of explicit memory-health impairment, affective self-stigma, and cognitive self-stigma; being younger; fewer self-care limitations; less severe psychiatric symptoms; and being unemployed and unmarried were found to significantly predict recovery. Findings support the validation of the ICF framework as a biopsychosocial recovery model and the use of this model in the development of effective recovery-oriented interventions for adults with SMI. Clinical and research implications are discussed.
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Granata N, Traversoni S, Kardas P, Kurczewska-Michalak M, Costa E, Midão L, Giardini A. Methodological features of quantitative studies on medication adherence in older patients with chronic morbidity: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:2132-2141. [PMID: 32402488 DOI: 10.1016/j.pec.2020.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/07/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The growing number of chronic, multimorbid older adults encourages healthcare systems to cope with polypharmacy and non-adherence. However, methodology on how to provide effective interventions to enhance medication adherence is still object of debate. METHODS To describe methodological features of quantitative studies concerning older adults' medication adherence, by means of a PRISMA systematic review (Scopus, PubMed, Medline). A specific focus was devoted to theoretical models and to the ABC Taxonomy model, as stated by the EMERGE guidelines. RESULTS 55 papers were included. Most of the studies were conducted using randomized control trials (63.6%) and focused on a single disease only (72.7%). Most of the interventions were provided by a single professional figure (70.9%). Medication adherence was mainly evaluated by means of questionnaires (61.8%) and by clinical records (30.9%). Sixteen studies considered a theoretical model in the intervention framework. The Initiation phase (ABC Taxonomy) was the most neglected. CONCLUSIONS Future studies upon medication adherence should account real-life challenges such as multimorbidity, polypharmacy and interdisciplinarity, analyzing adherence as a complex, holistic process. PRACTICE IMPLICATIONS Theoretical models may be useful to enhance the soundness of the results, to ease their comparability, to calibrate tailored strategies and to plan patient-centered interventions.
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Affiliation(s)
- Nicolò Granata
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Montescano, Pavia, Italy
| | - Silvia Traversoni
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Montescano, Pavia, Italy
| | - Przemysław Kardas
- Department of Family Medicine, Medical University of Lodz, Lodz, Poland
| | | | - Elísio Costa
- UCIBIO/REQUIMTE, Faculty of Pharmacy and Porto4Ageing, University of Porto, Porto, Portugal
| | - Luís Midão
- UCIBIO/REQUIMTE, Faculty of Pharmacy and Porto4Ageing, University of Porto, Porto, Portugal
| | - Anna Giardini
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Montescano, Pavia, Italy.
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Yıldız E, Aylaz R. How Counseling Based on Acceptance and Commitment Therapy and Supported with Motivational Interviewing Affects Levels of Functional Recovery in Patients Diagnosed with Schizophrenia: A Quasi-Experimental Study. Clin Nurs Res 2020; 30:599-615. [PMID: 32545996 DOI: 10.1177/1054773820935592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to determine how counseling based on acceptance and commitment therapy (ACT) and supported with motivational interviewing (MIs) affected functional recovery in individuals diagnosed with schizophrenia (IDSs). A quasi-experimental design was used. The participants of this study were 87 individuals diagnosed with schizophrenia (36 in the experimental group and 51 in the control group). The experimental group received counseling based on ACT and supported with MIs. The data were collected between September 2018 and May 2019 using a Descriptive Information Form and the Functional Remission of General Schizophrenia Scale (FROGS). The participants in the experimental group were given a group counseling program of eight sessions at community mental health centers in downtown Malatya, Turkey. The results revealed a statistically significant difference in the mean scores on FROGS between those in the IDS experimental group and those in the control group. The scores increased on both groups.
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Hernández C, Valdera CJ, Cordero J, López E, Plaza J, Albi M. Impact of telemedicine on assisted reproduction treatment in the public health system. J Healthc Qual Res 2019; 35:27-34. [PMID: 31883955 DOI: 10.1016/j.jhqr.2019.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/17/2019] [Accepted: 08/20/2019] [Indexed: 11/26/2022]
Abstract
AIM Telemedicine has helped to make health care more efficient. However, to date no studies have measured its impact on infertility and fertility healthcare. We assessed the potential care benefits and clinical advantages of an initiative implementing electronic patient portal (EPP) for patients scheduled to undergo assisted reproduction treatment, to reduce waiting times for medical consultation and treatment. METHODS This was designed as a retrospective cohort study. The experimental group comprised 1972 referral requests received by the assisted reproduction unit of our institution between 2015 and 2016, which were included in the group receiving telemedicine, while the control group was defined by 283 requests received in 2013, all of which were assigned face-to-face care. RESULTS We found a statistically significant reduction in the experimental group in terms of the days elapsed between the receipt of the assessment request and the first outpatient visit (68 days vs. 180 days, p<.001). Time to initiation of treatment was also significantly lower in this group (169 days vs. 229 days; p<.001). The experimental group contained around 7 times as many patients receiving treatment as the control group. No differences were observed in the pregnancy rate (29.9% vs. 31.1%; p=.77) or in the complication rate (3.2% vs. 0%; p=.16). CONCLUSIONS Use of telemedicine in electronic portal patient form reduces the total waiting time involved in patient requests for infertility treatment and indirectly increases the number of patients treated, causing no negative impact on treatment outcome.
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Affiliation(s)
- C Hernández
- Assisted Reproduction Unit, Fundación Jiménez Díaz, Madrid, Spain; Department of Obstetrics and Gynecology, Fundación Jiménez Díaz, Madrid, Spain
| | - C J Valdera
- Assisted Reproduction Unit, Fundación Jiménez Díaz, Madrid, Spain; Department of Obstetrics and Gynecology, Fundación Jiménez Díaz, Madrid, Spain.
| | - J Cordero
- Assisted Reproduction Unit, Fundación Jiménez Díaz, Madrid, Spain; Department of Obstetrics and Gynecology, Fundación Jiménez Díaz, Madrid, Spain
| | - E López
- Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - J Plaza
- Department of Obstetrics and Gynecology, Fundación Jiménez Díaz, Madrid, Spain
| | - M Albi
- Department of Obstetrics and Gynecology, Fundación Jiménez Díaz, Madrid, Spain
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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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Mobile technology for medication adherence in people with mood disorders: A systematic review. J Affect Disord 2018; 227:613-617. [PMID: 29172054 DOI: 10.1016/j.jad.2017.11.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/27/2017] [Accepted: 11/07/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Medication non-adherence is a critical challenge for many patients diagnosed with mood disorders (Goodwin and Jamison, 1990). There is a need for alternative strategies that improve adherence among patients with mood disorders that are cost-effective, able to reach large patient populations, easy to implement, and that allow for communication with patients outside of in-person visits. Technology-based approaches to promote medication adherence are increasingly being explored to address this need. The aim of this paper is to provide a systematic review of the use of mobile technologies to improve medication adherence in patients with mood disorders. METHODS A total of nine articles were identified as describing mobile technology targeting medication adherence in mood disorder populations. RESULTS Results showed overall satisfaction and feasibility of mobile technology, and reduction in mood symptoms; however, few examined effectiveness of mobile technology improving medication adherence through randomized control trials. LIMITATIONS Given the limited number of studies, further research is needed to determine long term effectiveness. CONCLUSIONS Mobile technologies has the potential to improve medication adherence and can be further utilized for symptom tracking, side effects tracking, direct links to prescription refills, and provide patients with greater ownership over their treatment progress.
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