Document Type
Article
Publication Date
4-2-2022
Abstract
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.
Keywords
antipsychotics, bipolar disorder, clinician survey, major depressive disorder, medication adherence
Language
English
Publication Title
Journal of Affective Disorders Reports
Rights
© 2022 The Author(s). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/), which permits non-commercial copying and redistribution of the material in any medium or format, provided the original work is not changed in any way and is properly cited.
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Recommended Citation
Sajatovic, Martha, "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" (2022). Faculty Scholarship. 1143.
https://commons.case.edu/facultyworks/1143