Measuring adherence to antipsychotic medications for schizophrenia: Concordance and validity among a community sample in rural China.
Measuring adherence to antipsychotic medications for schizophrenia: Concordance and validity among a community sample in rural China.
复制标题
衡量精神分裂症抗精神病药物的依从性：中国农村社区样本的一致性和有效性。
DOI：
10.1016/j.schres.2018.05.014
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发表时间：
2018
影响因子：
4.5
通讯作者：
He,Hua
中科院分区：
文献类型：
--
作者：
Xu,DongRoman;Gong,Wenjie;Gloyd,Steve;Caine,EricD;Simoni,Jane;Hughes,JamesP;Xiao,Shuiyuan;He,Wenjun;Dai,Bofeng;Lin,Meijuan;Nie,Juan;He,Hua
背景尽管有大量的措施来评估精神分裂症患者的药物治疗依从性，很少有研究评估他们的一致性和有效性对资源匮乏的社区环境中的参考标准。我们探讨了几种评估抗精神病药物治疗依从性的方法的一致性和有效性，在一个资源贫乏的社区，方法基于一个随机抽样的278名村民诊断为精神分裂症从浏阳，湖南省，中国，我们使用一致性相关系数（rc）和Kappa统计，以评估协议之间的药丸数，再填充记录，临床医生评级，药物态度量表（DAI），和简明依从性评定量表（BARS）。各种措施的有效性进行了评估，其一致性和敏感性/特异性，以家庭为基础的飞行药丸计数（UPC）作为参考standard.ResultsThe估计的依从性患者的比例根据所有措施（41% ~ 88%）是显着高于确定的UPC（35%）。任何两个测量之间的一致性较差（rc/Kappa大多<0.30）。尽管再填记录和结构化工具（BARS）的表现优于基于办公室的药丸计数和临床医生印象，但各种测量方法的有效性与UPC相比也很差（rc< 0.20; Kappa <0.16）。BARS，DAI和临床医生的评级是不敏感的变化，坚持和可能会低估任何程序effect.ConclusionIn资源贫乏的社区设置，在这项研究中评估的大多数措施不应该单独使用，因为他们高估了坚持，低估了程序的效果，并有不良的有效性。UPC和其他几项措施的组合可能会提供更多的洞察临床试验和程序管理。
BackgroundDespite 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.MethodBased 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.ResultsThe 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.ConclusionIn 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.