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Li XH, Deng SY, Zhang TM, Wang YZ, Wong IYL, Ran MS. Medication non-adherence and its influencing factors in persons with schizophrenia in rural China. J Ment Health 2024; 33:40-47. [PMID: 36322512 DOI: 10.1080/09638237.2022.2140789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Few studies have been conducted to explore medication non-adherence in persons with schizophrenia (PWS) and its influencing factors in rural China. This study aimed to investigate the medication non-adherence and its influencing factors among PWS in rural China. METHODS A total of 269 PWS and their family caregivers in Xinjin district, Chengdu, China were investigated on medication adherence and related factors. Logistic regression was employed to identify the influencing factors. RESULTS The results showed that 37.6% of PWS had medication non-adherence. PWS living with family caregivers had significantly lower rate of medication non-adherence (34.7%) than those not living with family caregivers (60.0%) (p < 0.01). Family caregivers' affiliate stigma of mental illness, knowledge of mental illness and self-esteem were significantly related to patients' medication non-adherence (p < 0.05). PWS' employment status, living with family caregiver, present mental status and social support were significantly related to medication adherence. CONCLUSION This study shows medication non-adherence is severe among PWS in rural China. Both patient- and family-related factors affect patients' medication adherence seriously. Except improving patients' treatment and mental status, development of family caregiving, social support network and intervention on reducing stigma of mental illness should be crucial for enhancing PWS' medication adherence.
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Affiliation(s)
- Xu-Hong Li
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, China
| | - Shu-Yu Deng
- Department of Social Work and Social Administration, University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Tian-Ming Zhang
- Department of Social Work, Shanghai University, Shanghai, China
| | - Yi-Zhou Wang
- Department of Social Work and Social Administration, University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Irene Yin Ling Wong
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
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Ralat SI, Rodríguez-Gómez J. The RAS-24: Development and validation of an adherence-to-medication scale for severe mental illness patients. J Clin Transl Sci 2023; 7:e94. [PMID: 37125053 PMCID: PMC10130847 DOI: 10.1017/cts.2023.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Several studies have found that most patients with severe mental illness (SMI) and comorbid (physical) conditions are partially or wholly nonadherent to their medication regimens. Nonadherence to treatment is a serious concern, affecting the successful management of patients with SMIs. Psychiatric disorders tend to worsen and persist in nonadherent patients, worsening their overall health. The study described herein aimed to develop and validate a scale (the Ralat Adherence Scale) to measure nonadherence behaviors in a culturally sensitive way. Materials and Methods Guided by a previous study that explored the primary reasons for nonadherence in Puerto Rican patients, we developed a pool of 147 items linked to the concept of adherence. Nine experts reviewed the meaning, content, clarity, and relevance of the individual items, and a content validity ratio was calculated for each one. Forty items remained in the scale's first version. This version was administered to 160 patients (21-60 years old). All the participants had a diagnosis of bipolar disorder, major depressive disorder, or schizoaffective disorder. The STROBE checklist was used as the reporting guideline. Results The scale had very good internal consistency (Cronbach's alpha = 0.812). After a factor analysis, the scale was reduced to 24 items; the new scale had a Cronbach's alpha of 0.900. Conclusions This adherence scale is a self-administered instrument with very good psychometric properties; it has yielded important information about nonadherence behaviors. The scale can help health professionals and researchers to assess patient adherence or nonadherence to a medication regimen.
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Affiliation(s)
- Sandra I. Ralat
- Department of Psychiatry, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
- Address for correspondence: Sandra I. Ralat, PhD, Department of Psychiatry, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, San Juan, Puerto Rico.
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Patel MX, Bent-Ennakhil N, Sapin C, di Nicola S, Loze JY, Nylander AG, Heres S. Attitudes of European physicians towards the use of long-acting injectable antipsychotics. BMC Psychiatry 2020; 20:123. [PMID: 32169077 PMCID: PMC7071632 DOI: 10.1186/s12888-020-02530-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 03/04/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prescription rates for long-acting injectable (LAI) antipsychotic formulations remain relatively low in Europe despite improved adherence over alternative oral antipsychotic treatments. This apparent under-prescription of LAI antipsychotics may have multiple contributing factors, including negative mental health practitioner attitudes towards the use of LAIs. METHODS The Antipsychotic Long acTing injection in schizOphrenia (ALTO) non-interventional study (NIS), conducted across several European countries, utilised a questionnaire that was specifically designed to address physicians' attitudes and beliefs towards the treatment of schizophrenia with LAI antipsychotics. Exploratory principal component analysis (PCA) of feedback from the questionnaire aimed to identify and characterize the factors that best explained the physicians' attitudes towards prescription of LAIs. RESULTS Overall, 136/234 solicited physicians returned fully completed questionnaires. Physicians' mean age was 48.5 years, with mean psychiatric experience of 20.0 years; 69.9% were male, 84.6% held a consultant position, and 91.9% had a clinical specialty in general adult care. Most physicians considered themselves to have a high level of clinical experience with LAI antipsychotics (77.2%), with an increased rate of LAI antipsychotics prescription over the last 5 years (59.6%). Although the majority of physicians (69.9%) declared feeling no difference in stress levels when offering LAI compared to oral antipsychotics, feelings of 'no/more stress' versus 'less stress' was found to influence prescription patterns. PCA identified six factors which collectively explained 66.1% of the variance in physician feedback. Multivariate analysis identified a positive correlation between physicians willing to accept usage of LAI antipsychotics and the positive attitude of colleagues (co-efficient 3.67; p = 0.016). CONCLUSIONS The physician questionnaire in the ALTO study is the first to evaluate the attitudes around LAI antipsychotics across several European countries, on a larger scale. Findings from this study offer an important insight into how physician attitudes can influence the acceptance and usage of LAI antipsychotics to treat patients with schizophrenia.
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Affiliation(s)
- Maxine X. Patel
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | | | | | | | | | - Stephan Heres
- grid.6936.a0000000123222966Department of Psychiatry and Psychotherapy, Munich Technical University, Munich, Germany
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Translation and cultural adaptation of Glasgow Antipsychotic Side-effects Scale (GASS) in Arabic. PLoS One 2018; 13:e0201225. [PMID: 30138349 PMCID: PMC6107124 DOI: 10.1371/journal.pone.0201225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/27/2018] [Indexed: 11/19/2022] Open
Abstract
Background In view of a constant increase in the number of patients treated with antipsychotic medications, the problem of nonadherence to the prescribed treatment becomes particularly relevant. Since one of the major contributors to the nonadherence is the presence of side effects of the drugs being used, the availability of tools for assessment of adverse reactions is of great importance. Objective The objective of the present work was to develop an Arabic language version of the Glasgow Antipsychotic Side-effect Scale (GASS). Methods After confirming the accuracy of translation, the questionnaire was given to 100 patients in two psychiatric centers in Saudi Arabia. Results The Cronbach’s alpha (0.793) indicated a good reliability of the survey. The mean GASS score was 19.09, indicating absent or mild side effects of antipsychotics, but 46% of patients experienced moderate, and 25% experienced severe side effects. An analysis of the correlation between patients’ characteristics and side effects revealed the presence of a positive relationship between the side effects and health literacy. Conclusions It is expected that the Arabic-GASS will benefit Arabic-speaking psychiatric patients by helping them to express their concerns about side effects of antipsychotics. The collected results also document the importance of patients’ health literacy in achieving high-quality healthcare.
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Llorca PM, Bobes J, Fleischhacker WW, Heres S, Moore N, Bent-Ennakhil N, Sapin C, Loze JY, Nylander AG, Patel MX. Baseline results from the European non-interventional Antipsychotic Long acTing injection in schizOphrenia (ALTO) study. Eur Psychiatry 2018; 52:85-94. [PMID: 29734130 DOI: 10.1016/j.eurpsy.2018.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/06/2018] [Accepted: 04/07/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Antipsychotic Long-acTing injection in schizOphrenia (ALTO) study was a non-interventional study across several European countries examining prescription of long-acting injectable (LAI) antipsychotics to identify sociodemographic and clinical characteristics of patients receiving and physicians prescribing LAIs. ALTO was also the first large-scale study in Europe to report on the use of both first- or second-generation antipsychotic (FGA- or SGA-) LAIs. METHODS Patients with schizophrenia receiving a FGA- or SGA-LAI were enrolled between June 2013 and July 2014 and categorized as incident or prevalent users. Assessments included measures of disease severity, functioning, insight, well-being, attitudes towards antipsychotics, and quality of life. RESULTS For the 572 patients, disease severity was generally mild-to-moderate and the majority were unemployed and/or socially withdrawn. 331/572 were prevalent LAI antipsychotic users; of whom 209 were prescribed FGA-LAI. Paliperidone was the most commonly prescribed SGA-LAI (56% of incident users, 21% of prevalent users). 337/572 (58.9%) were considered at risk of non-adherence. Prevalent LAI users had a tendency towards better insight levels (PANSS G12 item). Incident FGA-LAI users had more severe disease, poorer global functioning, lower quality of life, higher rates of non-adherence, and were more likely to have physician-reported lack of insight. CONCLUSIONS These results indicate a lower pattern of FGA-LAI usage, reserved by prescribers for seemingly more difficult-to-treat patients and those least likely to adhere to oral medication.
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Affiliation(s)
- Pierre-Michel Llorca
- University Hospital Center, EA 7280 University Clermont Auvergne, Clermont-Ferrand, France
| | - Julio Bobes
- Department of Psychiatry - CIBERSAM, University of Oviedo, Oviedo, Spain
| | - W Wolfgang Fleischhacker
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry, Medical University Innsbruck, Innsbruck, Austria
| | - Stephan Heres
- Department of Psychiatry and Psychotherapy, Munich Technical University, Munich, Germany
| | - Nicholas Moore
- Department of Pharmacology, University of Bordeaux, Bordeaux, France
| | | | | | - Jean-Yves Loze
- Otsuka Pharmaceutical Europe Ltd., Wexham, United Kingdom
| | | | - Maxine X Patel
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Abstract
Successful treatment of pediatric disorders has necessitated the development of alternative medication formulations, as children may prefer alternative dosage forms to tablets or capsules. This is especially true for attention-deficit/hyperactivity disorder (ADHD), which is one of the most common chronic pediatric conditions and often involves children with a variety of overlapping physical, psychological, or neurodevelopmental disorders. A special challenge for developing alternative dosage forms for ADHD treatment is the incorporation of a once-daily long-acting formulation. Traditional ADHD medication formulations have been limited, and issues surrounding prescribed dosing regimens-including poor medication adherence, difficulty swallowing, and the lack of dosing titration options-persist in ADHD treatment. In other disease areas, the development of alternative formulations has provided options for patients who have issues with consuming solid dosage forms, particularly children and individuals with developmental disorders. In the light of these new developments, several alternative formulations for ADHD medications are under development or have recently become available. This article reviews the various strategies for developing alternative dosage forms in other disease areas and discusses the application of these strategies in ADHD treatment. Alternative dosage forms may increase medication adherence, compliance, and patient preference and, therefore, improve the overall treatment for ADHD.
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Wykes T, Evans J, Paton C, Barnes TRE, Taylor D, Bentall R, Dalton B, Ruffell T, Rose D, Vitoratou S. What side effects are problematic for patients prescribed antipsychotic medication? The Maudsley Side Effects (MSE) measure for antipsychotic medication. Psychol Med 2017; 47:2369-2378. [PMID: 28420450 PMCID: PMC5820531 DOI: 10.1017/s0033291717000903] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Capturing service users' perspectives can highlight additional and different concerns to those of clinicians, but there are no up to date, self-report psychometrically sound measures of side effects of antipsychotic medications. Aim To develop a psychometrically sound measure to identify antipsychotic side effects important to service users, the Maudsley Side Effects (MSE) measure. METHOD An initial item bank was subjected to a Delphi exercise (n = 9) with psychiatrists and pharmacists, followed by service user focus groups and expert panels (n = 15) to determine item relevance and language. Feasibility and comprehensive psychometric properties were established in two samples (N43 and N50). We investigated whether we could predict the three most important side effects for individuals from their frequency, severity and life impact. RESULTS MSE is a 53-item measure with good reliability and validity. Poorer mental and physical health, but not psychotic symptoms, was related to side-effect burden. Seventy-nine percent of items were chosen as one of the three most important effects. Severity, impact and distress only predicted 'putting on weight' which was more distressing, more severe and had more life impact in those for whom it was most important. CONCLUSIONS MSE is a self-report questionnaire that identifies reliably the side-effect burden as experienced by patients. Identifying key side effects important to patients can act as a starting point for joint decision making on the type and the dose of medication.
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Affiliation(s)
- T. Wykes
- Psychology Department,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
- South London and Maudsley NHS Foundation
Trust, London UK
| | - J. Evans
- NIHR Biomedical Research Centre, South London and
Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology, and Neuroscience,
King's College London, London, UK
| | - C. Paton
- Chief Pharmacist, Oxleas NHS
Foundation Trust, Dartford, UK
| | | | - D. Taylor
- Pharmacy and Pathology, South
London and Maudsley NHS Foundation Trust, London,
UK
- Institute of Pharmaceutical Science, King's
College London, London, UK
| | - R. Bentall
- Department of Psychological Sciences,
University of Liverpool, UK
| | - B. Dalton
- Department for Psychological Medicine,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
| | - T. Ruffell
- Health Service & Population
Research, Centre for Implementation Science,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
| | - D. Rose
- Health Service & Population
Research, Centre for Implementation Science,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
| | - S. Vitoratou
- Health Service & Population
Research, Centre for Implementation Science,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
- Psychometrics and Measurement Lab,
Biostatistics and Health Informatics, Institute of
Psychiatry, Psychology, and Neuroscience, King's College London,
London, UK
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Hynes C, Keating D, McWilliams S, Madigan K, Kinsella A, Maidment I, Feetam C, Drake RJ, Haddad PM, Gaughran F, Taylor M, Clarke M. Glasgow Antipsychotic Side-effects Scale for Clozapine - Development and validation of a clozapine-specific side-effects scale. Schizophr Res 2015; 168:505-13. [PMID: 26276305 DOI: 10.1016/j.schres.2015.07.052] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/28/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The authors developed and validated a clozapine-specific side-effects scale capable of eliciting the subjectively unpleasant side-effects of clozapine. METHODS Questions from the original Glasgow Antipsychotic Side-effects Scale (GASS) were compared to a list of the most commonly reported clozapine side-effects and those with a significant subjective burden were included in the GASS for Clozapine (GASS-C). The original authors of the GASS and a group of mental health professionals from the UK and Ireland were enlisted to comment on the questions in the GASS-C based on their clinical experience. 110 clozapine outpatients from two sites completed the GASS-C, the original GASS and a repeat GASS-C. Statistical analyses were performed using SPSS for Windows version 19. RESULTS The GASS-C was shown to have construct validity, in that Spearman's correlation coefficient was 0.816 (p<0.001) with the original GASS, whilst Cohen's kappa coefficient was >0.77 (p<0.001) for one question and >0.81 (p<0.001) for remaining relevant questions. GASS-C was also shown to have strong test-retest reliability, in that Cronbach's alpha coefficient was >0.907 (p<0.001), whilst Cohen's kappa coefficient was >0.81 (p<0.001) for 12 questions and >0.61 (p<0.001) for the remaining four questions. CONCLUSION The GASS-C is a valid and reliable clinical tool to enable a systematic assessment of the subjectively unpleasant side-effects of clozapine. Future research should focus on how the scale can be utilised as a clinical tool to improve real-world outcomes such as adherence to clozapine therapy and quality of life.
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Affiliation(s)
- Caroline Hynes
- Saint John of God Hospital, Stillorgan, Co. Dublin, Ireland.
| | - Dolores Keating
- Saint John of God Hospital, Stillorgan, Co. Dublin, Ireland.
| | | | - Kevin Madigan
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland.
| | - Anthony Kinsella
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland.
| | - Ian Maidment
- Aston University, School of Life and Health Sciences, Birmingham, United Kingdom.
| | - Celia Feetam
- Aston University, School of Life and Health Sciences, Birmingham, United Kingdom.
| | - Richard J Drake
- University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
| | - Peter M Haddad
- Greater Manchester Health NHS Foundation Trust, Manchester, United Kingdom.
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, National Psychosis Unit, London, United Kingdom.
| | | | - Mary Clarke
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland.
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Mak KY, Lo WTL, Yeung WS, Wong M, Chung WSD, Chui E, Tam KL, Hui LK, Mui J, Chan OW, Wong KL. Consensus statements on adherence issues in schizophrenia for Hong Kong. Asian J Psychiatr 2014; 12:163-9. [PMID: 25440570 DOI: 10.1016/j.ajp.2014.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 06/17/2014] [Accepted: 06/22/2014] [Indexed: 12/31/2022]
Abstract
AIM In view of the clinical importance of the adherence issues in schizophrenia management, a consensus group of experienced local psychiatrists and nurse specialists gathered to outline a number of consensus statements for clinicians to consider enhancing adherence in their patients. PROCESS Prior to the consensus group meeting, three core members drafted eight statements on the issue of adherence in schizophrenia. Using a modified Delphi method, published literature and published guidelines regarding the management of schizophrenia were reviewed by the full panel during the group meeting. After discussion and reflection from each individual member of the consensus group, the eight statements were reworded and electronically voted on anonymously in two steps: acceptance on quality of evidence and practicability in implementation. RESULTS After modifications of the original statements, there was very high overall level of agreement and acceptance (reaching international standard) on all the five areas of adherence within the eight statements of the finalised statement. CONCLUSIONS The present consensus statements are the first in Hong Kong to address systematically adherence issues in schizophrenia management. They include areas on adherence assessment and definition, treatment strategies in enhancing adherence, and treatment considerations at specific phases of schizophrenia. They are tailored to be of practical utility in the local Hong Kong setting.
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Affiliation(s)
- K Y Mak
- Room 704, Alliance Building, 130-136 Connaught Road Central, Hong Kong.
| | - W T L Lo
- Kwai Chung Hospital, Kwai Chung, Hong Kong
| | - W S Yeung
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Michael Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | | | - E Chui
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - Ka-Lok Tam
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - L K Hui
- Department of Psychiatry, Kowloon Hospital, Hong Kong
| | | | - O W Chan
- Hong Kong Hospital Authority, Hong Kong
| | - K L Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
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Cao H, Shang H, Mu W, Zhai J, Hou Y, Wang H. Internal challenge to clinical trial project management: strategies for managing investigator compliance. J Evid Based Med 2013; 6:157-66. [PMID: 24325372 DOI: 10.1111/jebm.12053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 07/24/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Managing compliance in a clinical research, especially in a multi-centre randomized clinical trial (MRCT) is vital. We now feel the need to take a look at the once overlooked area of investigator compliance as it may provide resources necessary for producing satisfactory trial outcomes. OBJECTIVES To analyze investigator performance and examine their adherence behavior using data collected and information gained from the MISPS-TCM, a Chinese national research project. METHODS Four researchers were responsible for collecting relevant information and investigating the compliance behavior of participants in MISPS-TCM. The Data Management Committee of MISPS-TCM offered us the number of withdrawal at each site and other site information. Reports on investigator compliance events were provided by the Monitoring Committee. Records of any misconduct of or errors made by the investigator were collected from the Center's daily management diary. Other information sources included trial managers and investigators at the Center or at different sites of the study. RESULTS Investigator compliance can be an important determinant of trial outcomes and the degree of compliance may have detrimental effects on the reliability of findings of an MRCT, directly or indirectly. CONCLUSIONS Trial managers of future MRCTs should take a firm grip on investigator compliance from the following aspects. First, physicians should be provided with more opportunities. Second, we created and recommended the 'Five Step Method' for evaluating investigators. Third, measures must be taken to secure investigator compliance. Fourth, evaluation of investigator compliance in an MRCT needs to be made.
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Affiliation(s)
- Hongbo Cao
- Center for Clinical Research and Evaluation, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Taylor M, Cavanagh J, Hodgson R, Tiihonen J. Examining the effectiveness of antipsychotic medication in first-episode psychosis. J Psychopharmacol 2012; 26:27-32. [PMID: 22337711 DOI: 10.1177/0269881112439252] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The regular use of antipsychotic medication is known to improve overall outcomes and diminish risk of relapse, but applying the results of randomised controlled trials (RCTs) into routine clinical practice is not always straightforward. Furthermore, psychiatrists, service users and policy makers can have trouble keeping up with the burgeoning and, at times, conflicting results from research trials, meta-analysis and systematic reviews. In this paper we examine the differences between efficacy and effectiveness trials with regard to antipsychotic medication with a focus on first-episode psychosis, after reviewing the relative contribution of antipsychotic medication to outcomes in schizophrenia.
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Crowe M, Porter R, Inder M, Lacey C, Carlyle D, Wilson L. Effectiveness of interventions to improve medication adherence in bipolar disorder. Aust N Z J Psychiatry 2012; 46:317-26. [PMID: 22508592 DOI: 10.1177/0004867411428101] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To identify interventions that improve medication adherence in bipolar disorder. METHOD A review of the literature from 2004 to 2011 was conducted using Medline and manual searching. RESULTS Eleven studies were identified as meeting inclusion criteria. Five studies demonstrated improved medication adherence. No characteristics of the interventions, clinical characteristics of the groups or methodological factors distinguished those psychosocial interventions that demonstrated improvement from those that did not. CONCLUSIONS While only a few interventions improved adherence, most improved clinical outcomes. Issues were also identified about the way in which adherence is defined. It is proposed that incorporating patient preferences into measures of adherence within the context of a disorder-specific psychosocial intervention may provide an approach that demonstrates both improved adherence and improved clinical outcomes. However this requires further research.
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Affiliation(s)
- Marie Crowe
- Department of Psychological Medicine, University of Otago, New Zealand.
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Patients' reports of the factors influencing medication adherence in bipolar disorder - an integrative review of the literature. Int J Nurs Stud 2011; 48:894-903. [PMID: 21481391 DOI: 10.1016/j.ijnurstu.2011.03.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 01/24/2011] [Accepted: 03/11/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND As with other long-term conditions patients with bipolar disorder are rarely totally adherent or non-adherent. Rates of non-adherence have not changed since the first introduction of psychotropic medications in the 1950s despite vast numbers of new compounds being marketed. Non-adherence with medication in bipolar disorder is associated with affective relapse and consequently poor quality of life. The reasons that patients are non-adherent with medication are not well understood by clinicians who often assume it is related to the illness itself. OBJECTIVES To identify patients' perceptions of medication adherence in bipolar disorder. DESIGN An integrated review of the literature published between 1999 and 2010. DATA SOURCES Ovid (Medline, CINAHL, Embase, PsycINFO) and manual searching. REVIEW METHODS An integrative review of the literature was conducted which included: (a) problem formation, (b) literature search and initial screening, (c) gathering data from studies, (d) evaluating study quality, (e) data analysis and integration, (f) data interpretation, and (g) presentation of the findings. RESULTS Thirteen articles met criteria for inclusion in the review. These articles identified how patients reported their perceptions on medication and were integrated into four categories: illness factors, personal attitudes and beliefs, medication factors and environmental factors. CONCLUSIONS These findings suggest a need to address adherence from the full range of influencing factors (patient, illness, medication and environmental). Clinicians need to utilise a collaborative approach to working together with patients in order to identify the meaning that patients attribute to the symptoms, diagnosis, prognosis and medication. Understanding patients' perceptions and accepting these may facilitate greater medication adherence and the consequent improved clinical outcomes for patients with bipolar disorder.
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Mackay K, Taylor M, Patel MX. Medication adherence and patient choice in mental health. Br J Hosp Med (Lond) 2011; 72:6-7. [DOI: 10.12968/hmed.2011.72.1.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Staring ABP, Van der Gaag M, Koopmans GT, Selten JP, Van Beveren JM, Hengeveld MW, Loonen AJM, Mulder CL. Treatment adherence therapy in people with psychotic disorders: randomised controlled trial. Br J Psychiatry 2010; 197:448-55. [PMID: 21119150 DOI: 10.1192/bjp.bp.110.077289] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Interventions to improve adherence to treatment in people with psychotic disorders have produced inconclusive results. We developed a new treatment, treatment adherence therapy (TAT), whose intervention modules are tailored to the reasons for an individual's non-adherence. AIMS To examine the effectiveness of TAT with regard to service engagement and medication adherence in out-patients with psychotic disorders who engage poorly. METHOD Randomised controlled study of TAT v. treatment as usual (TAU) in 109 out-patients. Most outcome measurements were performed by masked assessors. We used intention-to-treat multivariate analyses (Dutch Trial Registry: NTR1159). RESULTS Treatment adherence therapy v. TAU significantly benefited service engagement (Cohen's d = 0.48) and medication adherence (Cohen's d = 0.43). Results remained significant at 6-month follow-up for medication adherence. Near-significant effects were also found regarding involuntary readmissions (1.9% v. 11.8%, P = 0.053). Symptoms and quality of life did not improve. CONCLUSIONS Treatment adherence therapy helps improve engagement and adherence, and may prevent involuntary admission.
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Affiliation(s)
- A B P Staring
- Erasmus University Medical Center, Department of Psychiatry, Rotterdam, The Netherlands.
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Gören JL, Parks JJ, Ghinassi FA, Milton CG, Oldham JM, Hernandez P, Chan J, Hermann RC. When Is Antipsychotic Polypharmacy Supported by Research Evidence? Implications for QI. Jt Comm J Qual Patient Saf 2008; 34:571-82. [DOI: 10.1016/s1553-7250(08)34072-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Horton RJ, Minniti A, Mireylees S, McEntegart D. A randomized trial to determine the impact on compliance of a psychophysical peripheral cue based on the Elaboration Likelihood Model. Contemp Clin Trials 2008; 29:823-8. [PMID: 18805509 DOI: 10.1016/j.cct.2008.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 08/17/2008] [Accepted: 08/25/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Non-compliance in clinical studies is a significant issue, but causes remain unclear. Utilizing the Elaboration Likelihood Model of persuasion, this study assessed the psychophysical peripheral cue 'Interactive Voice Response System (IVRS) call frequency' on compliance. METHODS 71 participants were randomized to once daily (OD), twice daily (BID) or three times daily (TID) call schedules over two weeks. Participants completed 30-item cognitive function tests at each call. Compliance was defined as proportion of expected calls within a narrow window (+/- 30 min around scheduled time), and within a relaxed window (-30 min to +4 h). Data were analyzed by ANOVA and pairwise comparisons adjusted by the Bonferroni correction. RESULTS There was a relationship between call frequency and compliance. Bonferroni adjusted pairwise comparisons showed significantly higher compliance (p=0.03) for the BID (51.0%) than TID (30.3%) for the narrow window; for the extended window, compliance was higher (p=0.04) with OD (59.5%), than TID (38.4%). CONCLUSION The IVRS psychophysical peripheral cue call frequency supported the ELM as a route to persuasion. The results also support OD strategy for optimal compliance. Models suggest specific indicators to enhance compliance with medication dosing and electronic patient diaries to improve health outcomes and data integrity respectively.
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Affiliation(s)
- Rachael Jane Horton
- School of Science and Technology, Nottingham Trent University, Nottingham, UK.
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Waddell L, Taylor M. A new self-rating scale for detecting atypical or second-generation antipsychotic side effects. J Psychopharmacol 2008; 22:238-43. [PMID: 18541624 DOI: 10.1177/0269881107087976] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We aimed to construct and assess a new self rating scale to detect the side effects of second generation antipsychotics. This scale was designed to allow a timely, sensitive and reliable method of gathering information on the number and severity of side effects an individual suffers from. The Glasgow Antipscyhotic Side-effect Scale (GASS) was developed after literature review, discussion with members of the mental health team and with service user feedback. Fifty indivudals taking second generation antipsychotics completed the GASS along with the Liverpool Univeristy Neuroleptic Side Effect Rating Scale, and one week later completed the GASS for a second time. Fifty comparison subjects also completed the GASS. The GASS was shown to have good discrimatory power and construct validity, along with good re-test reliablity, and is put forward as a short, helpful and valid clinical tool.
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Affiliation(s)
- L Waddell
- Southern General Hospital, Glasgow, UK.
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