A comparison of electronic monitoring vs. clinician rating of antipsychotic adherence in outpatients with schizophrenia

Byerly, Matthew J.; Fisher, Robert B.; Whatley, Katrina; Holland, Rhiannon; Varghese, Femina P.; Carmody, Thomas; Magouirk, Brianne; Rush, A. John

doi:10.1016/j.psychres.2004.11.002

Cited by 168 publications

(133 citation statements)

References 19 publications

Supporting

Mentioning

112

Contrasting

Unclassified

Order By: Relevance

“…Although MEMS caps are not the perfect measure of adherence, studies of other medications have suggested that clinicians do tend to overestimate adherence. [10][11][12] This finding highlights the need for clinicians to encourage appropriate pill-taking behavior, even if the patient appears to be doing so. Whereas clinicians were less likely to incorrectly label a patient adherent when they had information on pill counts, they still concluded that more than 75% of nonadherent participants were adherent.…”

Section: Discussionmentioning

confidence: 92%

Adherence to Warfarin Assessed by Electronic Pill Caps, Clinician Assessment, and Patient Reports: Results from the IN-RANGE Study

et al. 2007

View full text Add to dashboard Cite

BACKGROUND: Patient adherence to warfarin may influence anticoagulation control; yet, adherence among warfarin users has not been rigorously studied. OBJECTIVE:Our goal was to quantify warfarin adherence over time and to compare electronic medication event monitoring systems (MEMS) cap measurements with both self-report and clinician assessment of patient adherence. DESIGN:We performed a prospective cohort study of warfarin users at 3 Pennsylvania-based anticoagulation clinics and assessed pill-taking behaviors using MEMS caps, patient reports, and clinician assessments.RESULTS: Among 145 participants, the mean percent of days of nonadherence by MEMS was 21.8% (standard deviation±21.1%). Participants were about 6 times more likely to take too few pills than to take extra pills (18.8 vs. 3.3%). Adherence changed over time, initially worsening over the first 6 months of monitoring, which was followed by improvement beyond 6 months. Although clinicians were statistically better than chance at correctly labeling a participant's adherence (odds ratio=2.05, p=0.015), their estimates often did not correlate with MEMS-cap data; clinicians judged participants to be "adherent" at 82.8% of visits that were categorized as moderately nonadherent using MEMScap data (≥20% nonadherence days). Similarly, at visits when participants were moderately nonadherent by MEMS, they self-reported perfect adherence 77.9% of the time. CONCLUSIONS:These results suggest that patients may benefit from adherence counseling even when they claim to be taking their warfarin or the clinician feels they are doing so, particularly several months into their course of therapy.

show abstract

Section: Discussionmentioning

confidence: 92%

Adherence to Warfarin Assessed by Electronic Pill Caps, Clinician Assessment, and Patient Reports: Results from the IN-RANGE Study

et al. 2007

View full text Add to dashboard Cite

show abstract

“…Byerly et al 44 demonstrated a drastically underestimated antipsychotic non-adherence by clinicians when comparing antipsychotic adherence rates of outpatients assessed by electronic monitoring and by clinician rating. Therefore, we may also have underestimated non-adherence, leading to some inadequate TRS results.…”

Section: Discussionmentioning

confidence: 99%

Patterns of clozapine and other antipsychotics prescriptions in patients with treatment-resistant schizophrenia in community mental health centers in São Paulo, Brazil

Silveira¹,

Rocha²,

Àttux³

et al. 2015

Arch. Clin. Psychiatry (São Paulo)

View full text Add to dashboard Cite

Background: Despite of its global underuse, clozapine is still the golden standard antipsychotic for patients with treatment-resistant schizophrenia (TRS). Objective: To evaluate the patterns of clozapine and other antipsychotic drugs prescription in TRS in community mental health centers in São Paulo, Brazil. Methods: A multiple-choice questionnaire was applied to fifteen psychiatrists at five centers inquiring about patients' clinical condition, adherence to oral treatment and current antipsychotic treatment. History of previous and current antipsychotic treatment was collected through medical chart review. Results: Out of 442 schizophrenia patients, 103 (23.3%) fulfilled the criteria for TRS. Fifty-eight patients (56.3%) were receiving polypharmacy; 30 (29.1%) were on atypical antipsychotic monotherapy, 14 (13.6%) were on typical antipsychotic monotherapy, 25 (24.3%) were taking depot antipsychotic medication and only 22 (21.4%) were receiving clozapine. Discussion: As well as in other parts of the world, many TRS patients (78.6%) receive other drugs instead of clozapine in São Paulo, the best evidence-based medication for patients with TRS. The government should make every effort to provide medical training and the equipment and logistic support to adequately serve those who could benefit from clozapine treatment at the community health centers.

show abstract

“…Although many clinicians believe they can accurately estimate patient adherence, research shows that clinician estimates of patient adherence are often inaccurate [101][102][103][104][105]. Brief, validated self-report measures of adherence therefore have an important role to play in clinical practice, and some clinical guidelines recommend routine assessment of adherence by validated self-report measures [106].…”

Section: Contextual Considerations In Self-report Adherence Measuresmentioning

confidence: 99%

Self-report measures of medication adherence behavior: recommendations on optimal use

Stirratt

Dunbar‐Jacob

Crane

et al. 2015

Behav. Med. Pract. Policy Res.

605

528

View full text Add to dashboard Cite

Medication adherence plays an important role in optimizing the outcomes of many treatment and preventive regimens in chronic illness. Self-report is the most common method for assessing adherence behavior in research and clinical care, but there are questions about its validity and precision. The NIH Adherence Network assembled a panel of adherence research experts working across various chronic illnesses to review selfreport medication adherence measures and research on their validity. Self-report medication adherence measures vary substantially in their question phrasing, recall periods, and response items. Self-reports tend to overestimate adherence behavior compared with other assessment methods and generally have high specificity but low sensitivity. Most evidence indicates that self-report adherence measures show moderate correspondence to other adherence measures and can significantly predict clinical outcomes. The quality of self-report adherence measures may be enhanced through efforts to use validated scales, assess the proper construct, improve estimation, facilitate recall, reduce social desirability bias, and employ technologic delivery. Self-report medication adherence measures can provide actionable information despite their limitations. They are preferred when speed, efficiency, and low-cost measures are required, as is often the case in clinical care. KeywordsAdherence, Compliance, Self-management, Medication, Self-report Valid measurement of medication adherence plays a crucial role in healthcare and health research. When a patient is not benefiting from a medication regimen, clinicians need sound adherence information to determine whether the medication is ineffective or not being taken as prescribed. Assessing medication adherence during routine clinical care can further ensure that individuals in need of adherence support interventions receive them, ideally before deleterious outcomes occur. In the context of clinical research, proper interpretation of proof-of-concept trials testing new pharmacologic regimens requires valid adherence data, because any null findings may stem from poor adherence rather than a lack of drug efficacy. Research designed to understand and promote medication adherence also requires precise methods of adherence assessment.Among many approaches to assessing medication adherence, patient self-report measures remain the most common method [1][2][3][4][5][6]. These measures are defined by asking respondents to characterize their medication adherence behavior. Self-report measures of medication adherence range from simple singleitem questions regarding missed doses to complex multi-item assessments that incorporate reasons for nonadherence [7]. The widespread use of self-report adherence measures in clinical care and research reflects their low cost and ease of implementation across a large variety of medication regimens.There are two primary challenges related to selfreport measures of medication adherence. ImplicationsPractice: Routine assessment of medication...

show abstract

A comparison of electronic monitoring vs. clinician rating of antipsychotic adherence in outpatients with schizophrenia

Cited by 168 publications

References 19 publications

Adherence to Warfarin Assessed by Electronic Pill Caps, Clinician Assessment, and Patient Reports: Results from the IN-RANGE Study

Adherence to Warfarin Assessed by Electronic Pill Caps, Clinician Assessment, and Patient Reports: Results from the IN-RANGE Study

Patterns of clozapine and other antipsychotics prescriptions in patients with treatment-resistant schizophrenia in community mental health centers in São Paulo, Brazil

Self-report measures of medication adherence behavior: recommendations on optimal use

Contact Info

Product

Resources

About