Use of automated medication adherence monitoring in bipolar disorder research: pitfalls, pragmatics, and possibilities

Levin, Jennifer; Sams, Johnny; Tatsuoka, Curtis; Cassidy, Kristin A.; Sajatovic, Martha

doi:10.1177/2045125314566807

Cited by 28 publications

(43 citation statements)

References 30 publications

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“…Although the use of such monitors has the potential for increasing the reach of AEIs, the available devices remain relatively cost pro-C l i n i c a l r e s e a r c h hibitive for individuals with serious mental illness and for public mental health systems. 26 Also, it is not entirely clear from the available studies if the observed benefits of electronic monitors can be achieved only when they are used in combination with other supports-eg, a case worker who intervenes when problems with adherence arise-which would add to the costs and complexity of the deployment of these devices. Also, in some cases medications must be transferred to the electronic dispensers by the individuals themselves, who may have cognitive or motivational difficulties in repeatedly completing this task, prefer traditional medication containers or pill boxes, or require childproof containers.…”

Section: Discussionmentioning

confidence: 99%

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A review of behavioral tailoring strategies for improving medication adherence in serious mental illness

Kreyenbuhl

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Palmer-Bacon

2016

Dialogues in Clinical Neuroscience

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Nonadherence to psychopharmacological treatments poses a significant challenge to treatment success in individuals with serious mental illness, with upwards of 60% of people not taking their psychiatric medications as prescribed. Nonadherence is associated with adverse outcomes, including exacerbation of psychiatric symptoms, impaired functioning, increased hospitalizations and emergency room use, and increased health care costs. Whereas interventions using psychoeducation or cognitive approaches, such as motivational interviewing, have largely proven ineffective in improving adherence, approaches employing behavioral tailoring that incorporate medication taking into the daily routine and/or use environmental supports have shown promise. Recently, adherence-enhancing behavioral tailoring interventions that utilize novel technologies, such as electronic monitors and mobile phones, have been developed. Although interventions utilizing these platforms have the potential for widespread dissemination to a broad range of individuals, most require further empirical testing. This paper reviews selected behavioral tailoring strategies that aim to improve medication adherence and other functional outcomes among individuals with serious mental illness.

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Section: Discussionmentioning

confidence: 99%

“…25 Practically, the devices are often too bulky to keep on one's person and separate dispensers are needed to accommodate polypharmacy. 26 These and other characteristics of these devices limit their current utility in regular clinical practice.…”

Section: Discussionmentioning

confidence: 99%

A review of behavioral tailoring strategies for improving medication adherence in serious mental illness

Kreyenbuhl

Record

Palmer-Bacon

2016

Dialogues in Clinical Neuroscience

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“…Fourth, our method of identifying an index BD drug adherence based upon dosing frequency and most recent start date appeared to show that the index BD drug adherence was very tightly correlated with overall/average BD drug adherence. How to best measure medication adherence in BD, where use of multiple drugs is the norm, has yet to be definitely determined . An advantage of identifying an index/single drug to track for adherence, as was done in this study, is that this allows comparison with automated pill monitoring using MEMS.…”

Section: Discussionmentioning

confidence: 99%

Symptom severity, self‐reported adherence, and electronic pill monitoring in poorly adherent patients with bipolar disorder

et al. 2015

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Objectives This analysis of screening and baseline data from an ongoing trial examined self-report versus automated adherence monitoring and assessed the relationship between bipolar disorder (BD) symptoms and adherence in 104 poorly adherent individuals. Methods Adherence was measured with the Tablets Routine Questionnaire (TRQ) and the Medication Event Monitoring System (MEMS). Symptoms were measured with the Montgomery–Åsberg Depression Rating Scale (MADRS), the Young Mania Rating Scale (YMRS), and the Brief Psychiatric Rating Scale (BPRS). Results Mean age of the sample was 46.3 years [standard deviation (SD) = 9.41], with 72% (n = 75) women and 71% (n = 74) African American subjects. Adherence improved from screening to baseline with a mean missed drug proportion measured by TRQ of 61.43% (SD = 26.48) versus baseline mean of 46.61% (SD = 30.55). Mean proportion of missed medication using MEMS at baseline was 66.43% (SD = 30.40). Correlation between TRQ and MEMS was 0.47. Correlation between a single index drug and all BD medications was 0.95. Symptoms were generally positively correlated with TRQ (worse adherence = more severe symptoms), but in most instances was only at a trend level (p > 0.05) with the exception of correlation between baseline TRQ and MADRS and BPRS, which were positive (r = 0.20 and r = 0.21, respectively) and significant (p ≤ 0.05). Conclusions In patients with BD, monitoring increased adherence by 15%. MEMS identified 20% more non-adherence than self-report. Using a standard procedure to identify a single index drug for adherence monitoring may be one way to assess global adherence in patients with BD receiving polypharmacy treatment. Greater BD symptom severity may be a clinical indicator to assess for adherence problems.

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“…Adherence in SMI is very poor; estimated non-adherence rates for people diagnosed with schizophrenia range from 40 to 75 % [ 6 , 7 ]. Studies have found that 75 % of people with chronic schizophrenia discontinue their medication within 18 months [ 8 ] and non-adherence rates in bipolar disorder range between 20 and 60 % with a mean of 41 % [ 9 , 10 ]. Antipsychotic prescribing lends itself to SDM, because the adverse event profile is the main factor in the choice of antipsychotics [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Mental health pharmacists views on shared decision-making for antipsychotics in serious mental illness

et al. 2016

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Background People diagnosed with serious mental illnesses (SMIs) such as schizophrenia and bipolar affective disorder are frequently treated with antipsychotics. National guidance advises the use of shared decision-making (SDM) in antipsychotic prescribing. There is currently little data on the opinions of health professionals on the role of SDM. Objective To explore the views and experiences of UK mental health pharmacists regarding the use of SDM in antipsychotic prescribing in people diagnosed with SMI. Setting The study was conducted by interviewing secondary care mental health pharmacists in the UK to obtain qualitative data. Methods Semi-structured interviews were recorded. An inductive thematic analysis was conducted using the method of constant comparison. Main outcome measure Themes evolving from mental health pharmacists on SDM in relation to antipsychotic prescribing in people with SMI. Results Thirteen mental health pharmacists were interviewed. SDM was perceived to be linked to positive clinical outcomes including adherence, service user satisfaction and improved therapeutic relations. Despite more prescribers and service users supporting SDM, it was not seen as being practised as widely as it could be; this was attributed to a number of barriers, most predominantly issues surrounding service user’s lacking capacity to engage in SDM and time pressures on clinical staff. The need for greater effort to work around the issues, engage service users and adopt a more inter-professional approach was conveyed. Conclusion The mental health pharmacists support SDM for antipsychotic prescribing, believing that it improves outcomes. However, barriers are seen to limit implementation. More research is needed into overcoming the barriers and measuring the benefits of SDM, along with exploring a more inter-professional approach to SDM.Electronic supplementary materialThe online version of this article (doi:10.1007/s11096-016-0352-z) contains supplementary material, which is available to authorized users.

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Use of automated medication adherence monitoring in bipolar disorder research: pitfalls, pragmatics, and possibilities

Cited by 28 publications

References 30 publications

A review of behavioral tailoring strategies for improving medication adherence in serious mental illness

A review of behavioral tailoring strategies for improving medication adherence in serious mental illness

Symptom severity, self‐reported adherence, and electronic pill monitoring in poorly adherent patients with bipolar disorder

Mental health pharmacists views on shared decision-making for antipsychotics in serious mental illness

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