The effect of objectively collected medication adherence information on bipolar I and major depressive disorder treatment decisions: A randomized case vignette study of psychiatric clinicians

Journal of Affective Disorders Reports

Joshua N. Liberman¹  Dawn I. Velligan²  Tigwa H. Davis³  Martha Sajatovic³  Charles Ruetsch³  Felicia Forma³  Emily K. Wiggins⁴ 

[1] Corresponding author.;Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States;Health Analytics, LLC 9200 Rumsey Rd Suite 215, Columbia, MD 21045, United States;University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, United States;

关键词: Bipolar disorder;    Major depressive disorder;    Medication adherence;    Antipsychotics;    Clinician survey;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Adherence to antipsychotic medications is critical for treatment and relapse prevention in serious mental illness. Accurate assessment of medication adherence can be difficult, clinicians frequently overestimate patient adherence, and new accurate methods assessing medication adherence are needed. This study estimated the influence of antipsychotic medication adherence information on clinician treatment decisions among patients with bipolar I (BD) and major depressive (MDD) disorders. Methods: This study was a cross-sectional, random assignment survey of psychiatric clinicians who prescribe medication for the treatment of BD and/or MDD. Clinicians (N = 180) were recruited using national association lists and were presented with either BD or MDD case vignettes that described symptoms, level of functioning, and self-reported medication adherence. Cases were randomly assigned to vignettes that presented subjective (self-report) or objective adherence (from refill rates and MEMS caps data) information. Respondents were asked to recommend adjustments in medication regimen. Results: A total of 180 clinicians participated. In the BD arm (N = 90), participants were primarily female (55.5%), and specialized in psychiatry (97.8%). In the MDD arm (N = 90), participants were primarily female (64.4%) and specialized in psychiatry (98.9%). The BD arm was more likely to modify antipsychotic treatment as opposed to mood stabilizers and the MDD arm was more likely to modify antidepressant treatment as opposed to antipsychotic prescriptions. Among vignettes indicating non-adherence, cases that reviewed objective adherence data were more likely to adopt medication adherence enhancing interventions including long-acting injectable antipsychotics. As expected, the rate of LAI choice overall was greater for cases reviewing BD compared to those reviewing MDD vignettes. Limitations: This study utilized a convenience sample and synthetic vignettes. The survey response arrays do not cover the full array of treatment options available to all clinicians. Conclusions: These data suggest the presence of objective adherence data may help clinicians distinguish between medication nonresponse and medication nonadherence as illustrated by the relationship between the presence of objective adherence information and selection of treatment modifications.

【 授权许可】

Unknown