Measurement of psychiatric treatment adherence

Abstract

Objective-Nonadherence to medications for mental disorders substantially limits treatment effectiveness and results in higher rates of relapse, hospitalization, and disability. Accurate measurement of medication adherence is important not only in adherence research, but also in clinical trials in which medications are being evaluated, and in clinical practice where failure to detect nonadherence results in premature medication changes, unnecessary polypharmacy, and greater likelihoods of functional deteriorations and hospitalizations. This is a review of psychiatric treatment adherence methods and measures arising from a meeting on "Methodological Challenges in Psychiatric Treatment Adherence Research" held on September 27-28, 2007 in Bethesda, MD and organized by the National Institute of Mental Health (NIMH).Methods-This paper reviews the range of modalities currently available for assessing adherence behavior including pill counts, pharmacy records, technology-assisted monitoring, biological assays, and a range of self-report and interviewer-rated scales. Measures of adherence attitudes are also reviewed.Results-Each of the adherence measures described are imperfect estimates of actual medication ingestion but each provides informative estimates of adherence or the attitudinal factors associated with adherence. Measure selection depends on a range of factors including the patient sample, the context in which the measure is being used, and the clinical outcomes expected from various levels of nonadherence. The use of multiple measures of adherence is encouraged to balance the limitations of individual measures.Conclusion-While adherence assessment has become increasingly sophisticated in recent years there remains a need for refinement and expansion on currently available methods and measures.

Methodological Considerations in Estimating Adherence and Persistence for a Long-Acting Injectable Medication

“…As the focus is on methodology, rather than on patient adherence/persistence, a single oral and a single M easures of medication adherence and persistence are becoming increasingly valuable, since lack of adherence has been associated with adverse outcomes and higher costs of care. [1][2][3][4][5] Medication adherence/persistence is also an important component in the calculation of indicators used by policymakers to assess quality of care and to determine pay and performance goals, such as with the Healthcare Effectiveness Data and Information Set. 6 Adherence/persistence terminology, definitions, and methods of measurements vary extensively in published literature.…”

“…We cannot assume that pharmacy records are accurate. 5 Depending on the study size and on whether adherence is the primary outcome, the cost of other adherence collection techniques such as electronic monitoring should be weighed against the needed precision. 5 …”

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

“…To help improve available information on measures, adherence-related publications should include a clear description of any self-report measure and its administration method, along with descriptive data resulting from the measure (e.g., mean, median, standard deviation) [9,35]. Define the adherence construct you want to assess-It is important to define the specific construct of interest when conducting medication adherence assessments and to select an appropriately corresponding measure [7,52,59,60]. Voils and colleagues [12,52,61] have argued that self-report adherence measures often conflate two distinct constructs-the extent of nonadherence and reasons for nonadherence-and this conflation may be one factor that has limited the psychometric properties and validity of many existing self-report measures.…”

Prevalencia y factores asociados a la no adherencia en el tratamiento farmacológico de mantenimiento en adultos con trastorno afectivo bipolar*

“…En tal instrumento, si se responde NO a los cuatro ítems que lo conforman se considera que el paciente resulta adherente; en contraposición si responde afirmativamente al menos en un ítem, es considerado no adherente, la sensibilidad es de 0.81 una especificidad 0.44 fiabilidad ( cronbach) es 0.61, (26,27).…”

“…En la presente investigación se utilizó el cuestionario de Morisky -Green como un método indirecto subjetivo para medir la adherencia al tratamiento farmacológico de mantenimiento, el cual presenta ventaja frente a otros métodos por su rapidez para utilizarlos, buena fiabilidad, el bajo costo frente a pruebas de niveles en sangre o monitorización con dispositivos, Scott encontró que cuando un paciente en un autoreporte informaban adherencia o no adherencia, los hallazgos de niveles en sangre del fármaco se correlacionaba . (26,27,28).…”