Comparison of methods to assess psychiatric medication adherence in methadone-maintained patients with co-occurring psychiatric disorder.
Comparison of methods to assess psychiatric medication adherence in methadone-maintained patients with co-occurring psychiatric disorder.
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DOI：
10.1016/j.drugalcdep.2016.01.016
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发表时间：
2016-03-01
影响因子：
4.2
通讯作者：
Brooner RK
中科院分区：
文献类型：
--
作者：
Dunn KE;King VL;Brooner RK
坚持使用精神科药物是一个严重影响个人和公共健康的关键问题。这是对一项大规模药物使用和精神障碍的临床治疗试验的二次分析。受试者(n=153)在12个月的研究期间接受了30天的临床指示精神药物治疗，并提供了药物事件监测系统(MEMS)和Morisky药物服用依从性量表(MMAS)的相应数据，他们的依从性自我报告评级被包括在分析中。MEMS盖子开口的精确度是根据每个参与者独特的所需剂量计划定制的。与预期一致，基于MEMS的依从性随着时间的推移缓慢下降，尽管MMA忘记药物的得分仍然很高，并且在12个月的研究中没有变化。MEMS帽的开口不受任何基线或治疗水平变量的显著影响，而MMAS评分与年龄较小、存在轴心I障碍和反社会人格障碍或任何B簇诊断有关。结果表明，与MMAS自我报告相比，MEMS CAPS可能是一种更客观的方法来监测同时存在药物使用和精神障碍的患者的依从性。在这项研究中，参与者能够成功地使用MEMS盖子12个月，其中1%的盖子丢失或损坏，这表明这些共存的人群能够成功地使用MEMS。最终，这些数据表明，与自我报告相比，监测该治疗人群依从性的客观方法可以产生更准确的结果。
Adherence with psychiatric medication is a critical issue that has serious individual and public health implications. This is a secondary analysis of a large-scale clinical treatment trial of co-occurring substance use and psychiatric disorder. Participants (n=153) who received a clinically-indicated psychiatric medication >30 days during the 12-month study and provided corresponding data from Medication Event Monitoring System (MEMS) and Morisky Medication Taking Adherence Scale (MMAS) self-report adherence ratings were included in the analyses. Accuracy in MEMS caps openings was customized to each participant’s unique required dosing schedule. Consistent with expectations, MEMS-based adherence declined slowly over time, though MMAS scores of forgetting medication remained high and did not change over the 12-month study. MEMS caps openings were not significantly impacted by any baseline or treatment level variables, whereas MMAS scores were significantly associated with younger age and presence of an Axis I disorder and antisocial personality disorder, or any cluster B diagnoses. Results suggest that MEMS caps may be a more objective method for monitoring adherence in patients with co-occurring substance use and psychiatric disorder relative to the MMAS self-report. Participants in this study were able to successfully use the MEMS caps for a 12-month period with <1% lost or broken caps, suggesting this comorbid population is able to use the MEMS successfully. Ultimately, these data suggest that an objective method for monitoring adherence in this treatment population yield more accurate outcomes relative to self-report.