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Twelve months of electronic monitoring (MEMS®) in the Swedish COAST-study: a comparison of methods for the measurement of adherence in schizophrenia.
Eur Neuropsychopharmacol. 2014 Feb; 24(2):215-22.EN

Abstract

The primary aim was to compare objective and subjective measures of adherence in a naturalistic cohort of schizophrenia outpatients over 12 months between October 2008 and June 2011. Antipsychotic medication adherence was monitored in 117 outpatients diagnosed with schizophrenia or schizophrenia-like psychosis according to DSM-IV criteria in a naturalistic prospective study. Adherence was determined by the Medication Event Monitoring System (MEMS®), pill count, plasma levels and patient, staff, psychiatrist and close informant ratings. The plasma level adherence measure reflects adherence to medication and to lab visits. Relationships between MEMS® adherence and other measures were expressed as a concordance index and kappa (K). Non-adherence (MEMS® ≤0.80) was observed in 27% of the patients. MEMS® adherence was highly correlated with pill count (concordance= 89% and K=0.72, p<0.001). Concordance and K were lower for all other adherence measures and very low for the relationship between MEMS® adherence and plasma levels (concordance=56% and K=0.05, p=0.217). Adherence measures were also entered into a principal component analysis that yielded three components. MEMS® recordings, pill count and informant ratings had their highest loadings in the first component, plasma levels alone in the second and patient, psychiatrist and staff ratings in the third. The strong agreement between MEMS® and pill count suggests that structured pill count might be a useful tool to follow adherence in clinical practice. The large discrepancy between MEMS® and the adherence measure based on plasma levels needs further study in clinical settings.

Authors+Show Affiliations

Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden; Nå Ut-teamet, Psychosis Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: cecilia.brain@vgregion.se.Nå Ut-teamet, Psychosis Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden.Nå Ut-teamet, Psychosis Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden.Department of Neuroscience, Uppsala University Hospital, Uppsala, Sweden.Department of Psychosis Studies, Institute of Psychiatry at the Maudsley, King's College London, United Kingdom.Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom.Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24359935

Citation

Brain, Cecilia, et al. "Twelve Months of Electronic Monitoring (MEMS®) in the Swedish COAST-study: a Comparison of Methods for the Measurement of Adherence in Schizophrenia." European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology, vol. 24, no. 2, 2014, pp. 215-22.
Brain C, Sameby B, Allerby K, et al. Twelve months of electronic monitoring (MEMS®) in the Swedish COAST-study: a comparison of methods for the measurement of adherence in schizophrenia. Eur Neuropsychopharmacol. 2014;24(2):215-22.
Brain, C., Sameby, B., Allerby, K., Lindström, E., Eberhard, J., Burns, T., & Waern, M. (2014). Twelve months of electronic monitoring (MEMS®) in the Swedish COAST-study: a comparison of methods for the measurement of adherence in schizophrenia. European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology, 24(2), 215-22. https://doi.org/10.1016/j.euroneuro.2013.11.013
Brain C, et al. Twelve Months of Electronic Monitoring (MEMS®) in the Swedish COAST-study: a Comparison of Methods for the Measurement of Adherence in Schizophrenia. Eur Neuropsychopharmacol. 2014;24(2):215-22. PubMed PMID: 24359935.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Twelve months of electronic monitoring (MEMS®) in the Swedish COAST-study: a comparison of methods for the measurement of adherence in schizophrenia. AU - Brain,Cecilia, AU - Sameby,Birgitta, AU - Allerby,Katarina, AU - Lindström,Eva, AU - Eberhard,Jonas, AU - Burns,Tom, AU - Waern,Margda, Y1 - 2013/12/04/ PY - 2013/08/23/received PY - 2013/11/24/revised PY - 2013/11/27/accepted PY - 2013/12/24/entrez PY - 2013/12/24/pubmed PY - 2014/10/22/medline KW - Adherence KW - Antipsychotics KW - Medication Event Monitoring System KW - Pill count KW - Plasma levels KW - Schizophrenia SP - 215 EP - 22 JF - European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology JO - Eur Neuropsychopharmacol VL - 24 IS - 2 N2 - The primary aim was to compare objective and subjective measures of adherence in a naturalistic cohort of schizophrenia outpatients over 12 months between October 2008 and June 2011. Antipsychotic medication adherence was monitored in 117 outpatients diagnosed with schizophrenia or schizophrenia-like psychosis according to DSM-IV criteria in a naturalistic prospective study. Adherence was determined by the Medication Event Monitoring System (MEMS®), pill count, plasma levels and patient, staff, psychiatrist and close informant ratings. The plasma level adherence measure reflects adherence to medication and to lab visits. Relationships between MEMS® adherence and other measures were expressed as a concordance index and kappa (K). Non-adherence (MEMS® ≤0.80) was observed in 27% of the patients. MEMS® adherence was highly correlated with pill count (concordance= 89% and K=0.72, p<0.001). Concordance and K were lower for all other adherence measures and very low for the relationship between MEMS® adherence and plasma levels (concordance=56% and K=0.05, p=0.217). Adherence measures were also entered into a principal component analysis that yielded three components. MEMS® recordings, pill count and informant ratings had their highest loadings in the first component, plasma levels alone in the second and patient, psychiatrist and staff ratings in the third. The strong agreement between MEMS® and pill count suggests that structured pill count might be a useful tool to follow adherence in clinical practice. The large discrepancy between MEMS® and the adherence measure based on plasma levels needs further study in clinical settings. SN - 1873-7862 UR - https://www.unboundmedicine.com/medline/citation/24359935/Twelve_months_of_electronic_monitoring__MEMS®__in_the_Swedish_COAST_study:_a_comparison_of_methods_for_the_measurement_of_adherence_in_schizophrenia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0924-977X(13)00344-1 DB - PRIME DP - Unbound Medicine ER -