Document Detail


A prospective study of risk factors for nonadherence with antipsychotic medication in the treatment of schizophrenia.
MedLine Citation:
PMID:  16889456     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study aimed to prospectively identify the best single predictor and the best set of predictors of risk for nonadherence with anti-psychotic medication in the treatment of patients with schizophrenia. METHOD: We used data from 1579 patients in a 3-year, prospective, naturalistic, nonrandomized, multisite study of schizophrenia patients conducted from July 1997 to September 2003 (U.S. Schizophrenia Care and Assessment Program). Adherence with any oral antipsychotic medication was assessed using patient-reported medication adherence and an indirect adherence measure based on medical record prescription information. Patients who reported poor medication adherence or had a medication possession ratio < or = 80% (percentage of days with prescriptions for any oral antipsychotic) during the first year after enrollment were defined as nonadherent (N = 296, 18.8%). Thirty-nine previously reported potential risk factors of nonadherence with antipsychotic medication were assessed at enrollment with valid and reliable measures. Risk factors represented patient-, environment-, and treatment-related domains, including sociodemographics, symptom severity, substance use, threat to safety of self and others, other illness-related factors, need for supervision, medication-related adverse events, and prior medication-utilization patterns. RESULTS: The best single predictor of future nonadherence was nonadherence during the 6 months prior to enrollment (odds ratio = 4.1, 95% confidence interval = 3.1 to 5.6, p < .001). The best set of predictors of nonadherence, ordered by strength of association, included prior non-adherence, recent illicit drug use, recent alcohol use, prior treatment with antidepressants, and greater patient-reported, medication-related cognitive impairment. CONCLUSION: Nonadherence with antipsychotic medication is associated with a well-defined set of risk factors that can be used to identify patients who are predisposed to poor adherence.
Authors:
Haya Ascher-Svanum; Baojin Zhu; Douglas Faries; Jonathan P Lacro; Christian R Dolder
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of clinical psychiatry     Volume:  67     ISSN:  0160-6689     ISO Abbreviation:  J Clin Psychiatry     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-08-07     Completed Date:  2006-08-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7801243     Medline TA:  J Clin Psychiatry     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1114-23     Citation Subset:  IM    
Affiliation:
Eli Lilly and Co., Lilly Corporate Center, Indianapolis, IN 46285, USA. haya@lilly.com
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Adult
Antidepressive Agents / therapeutic use
Antipsychotic Agents / administration & dosage,  adverse effects,  therapeutic use*
Cognition Disorders / chemically induced,  diagnosis,  epidemiology
Drug Utilization
Female
Follow-Up Studies
Health Status
Humans
Longitudinal Studies
Male
Medical Records / statistics & numerical data
Prospective Studies
Psychiatric Status Rating Scales / statistics & numerical data
Risk Factors
Schizophrenia / drug therapy*,  epidemiology
Schizophrenic Psychology
Treatment Refusal / statistics & numerical data*
United States
Chemical
Reg. No./Substance:
0/Antidepressive Agents; 0/Antipsychotic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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