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Schizophrenia Bulletin Advance Access originally published online on May 17, 2006
Schizophrenia Bulletin 2006 32(4):724-742; doi:10.1093/schbul/sbj075
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© The Author 2006. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

Defining and Assessing Adherence to Oral Antipsychotics: A Review of the Literature

Dawn I. Velligan1,2, Yui-Wing Francis Lam3, David C. Glahn2, Jennifer A. Barrett2, Natalie J. Maples2, Larry Ereshefsky4 and Alexander L. Miller2
2 Department of Psychiatry, University of Texas Health Science Center at San Antonio
3 Department of Pharmacology, University of Texas Health Science Center at San Antonio
4 California Clinical Trials, Glendale, CA

1To whom correspondence should be addressed; Department of Psychiatry, University of Texas Health Science Center at San Antonio, Mail Code 7792, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, e-mail: velligand{at}uthscsa.edu

The definition and assessment of adherence vary considerably across studies. Increasing consensus regarding these issues is necessary to improve our understanding of adherence and the development of more effective treatments. We review the adherence literature over the past 3 decades to explore the definitions and assessment of adherence to oral antipsychotics in schizophrenia patients. A total of 161 articles were identified through MEDLINE and PsycINFO searches. The most common method used to assess adherence was the report of the patient. Subjective and indirect methods including self-report, provider report, significant other report, and chart review were the only methods used to assess adherence in over 77% (124/161) of studies reviewed. Direct or objective measures including pill count, blood or urine analysis, electronic monitoring, and electronic refill records were used in less than 23% (37/161) of studies. Even in studies utilizing the same methodology to assess adherence, definitions of an adherent subject varied broadly from agreeing to take any medication to taking at least 90% of medication as prescribed. We make suggestions for consensus development, including the use of recommended terminology for different subject samples, the increased use of objective or direct measures, and the inclusion in all studies of an estimate of the percentage of medication taken as prescribed in an effort to increase comparability among studies. The suggestions are designed to advance the field with respect to both understanding predictors of adherence and developing interventions to improve adherence to oral antipsychotic medications.

Keywords: adherence / oral antipsychotics / schizophrenia


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