Electronic monitoring helps identify antipsychotic nonadherence
<<; Back
23 February 2007
The Medication Event Monitoring system (MEMS) effectively monitors
adherence to antipsychotic medication, research findings reveal.
Gary Remington (University of Toronto, Ontario, Canada) and
colleagues found that MEMS detected nonadherence in around half of 52
patients with schizophrenia or schizoaffective disorder. This was
considerably higher than that noted with other measures, including
self-report (3%) or pill count (24%).
MEMS consists of a microprocessor that is inserted in a medication
bottle cap and records the occurrence and time of each bottle opening.
"More sophisticated measurement tools such as MEMS may assist us in
better understanding how level and pattern of antipsychotic
noncompliance, factors that at present remain poorly understood,
impact on symptom exacerbation," the team says.
The researchers used a threshold rate of 80% to represent a level of
compliance necessary to achieve therapeutic response.
Using this approach, compliance rates for self-report, clinician
estimate, pill count, and MEMS were 97%, 78%, 76%, and 48%,
respectively.
Remington et al note in the journal Schizophrenia Research that
clinicians' ability to predict compliance was limited, as 42% of the
patients who they identified as being compliant were found to be
noncompliant using MEMS.
Conversely, 44% of the patients they classified as being noncompliant
were actually compliant according to MEMS data.
Factors consistently associated with nonadherence were more severe
symptoms and increased dosing complexity, for example, having to take
medications more than once a day.
MEMS may therefore provide a more detailed account of pattern intake
and help identify nonadherent patients. However, the authors
acknowledge that it remains unclear as to what threshold of
noncompliance is associated with a compromise in clinical response
and a risk of symptom exacerbation.
They suggest that MEMS could be best used to measure patterns of
compliance, "since it may be that relapse rates are more closely
linked to prolonged intervals off antipsychotic medication than, say,
a pattern of missed doses that still ensures some degree of ongoing
antipsychotic exposure."
They conclude: "More precise evaluation tools, such MEMS, may assist
us in answering these questions."
http://www.psychiatrysource.com/NewsItem/Electronic-monitoring-helps-
identify-antipsychotic.aspx?l1=3&firstpage=true
Source: Schizophr Res 2007; 90: 229–237
©Current Medicine Group Ltd
.
