Department of Psychiatry, Korea University College of Medicine, Ansan Hospital, Ansan, Republic of Korea. ; Korea University Research Institute of Mental Health, Seoul, Republic of Korea.
Psychiatry Investig. 2012 Sep;9(3):263-8. doi: 10.4306/pi.2012.9.3.263. Epub 2012 Sep 6.
The primary aim of this study was to compare electronic monitoring with other measures of adherence to Osmotic-controlled Release Oral delivery System methylphenidate in children with attention-deficit hyperactivity disorder (ADHD). The secondary aim was to analyze the relationships between adherence and clinical factors, including ADHD symptoms.
Thirty-nine children diagnosed with ADHD were monitored for adherence to medication over the course of eight weeks. Medication adherence was assessed using the Medication Event Monitoring System (MEMS), which is a bottle cap with a microprocessor that records all instances and times that the bottle is opened; patient self-report; clinician rating; and pill count. Information, including demographic and clinical characteristics, symptom rating scale, and psychological test results, were also collected. The relationships between adherence and clinical factors, including ADHD rating scores of baseline and of the changes, were assessed.
The rate of non-adherence measured by the MEMS was found to be 46.2%, which was considerably higher than those of the patient self-report (17.9%), clinician rating (31.7%), and pill count (12.8%) of non-adherence. The rate of adherence measured by the MEMS was not significantly associated with baseline symptom severity or symptom changes over the eight weeks, although non-adherent group showed more severe baseline symptoms and inferior improvement.
Adherence as measured by the MEMS showed a discrepancy with other measures of adherence in patients with ADHD. The symptom severity and level of improvement were not related to adherence with MEMS. Further studies are needed to evaluate the variables that may impact medication adherence in children with ADHD.
本研究的主要目的是比较电子监测与其他评估注意缺陷多动障碍（ADHD）儿童服用渗透控释口服美金刚哌甲酯依从性的方法。次要目的是分析依从性与临床因素之间的关系，包括 ADHD 症状。
39 名被诊断为 ADHD 的儿童在 8 周的时间内接受药物依从性监测。使用 Medication Event Monitoring System（MEMS）评估药物依从性，这是一种带有微处理器的瓶盖，可记录瓶子打开的所有时间和次数；患者自我报告；临床医生评估；以及药丸计数。还收集了包括人口统计学和临床特征、症状评分量表和心理测试结果在内的信息。评估了依从性与包括基线和变化的 ADHD 评分在内的临床因素之间的关系。
MEMS 测量的不依从率为 46.2%，明显高于患者自我报告（17.9%）、临床医生评估（31.7%）和药丸计数（12.8%）的不依从率。尽管不依从组的基线症状更严重，改善效果更差，但 MEMS 测量的依从率与基线症状严重程度或八周内症状变化均无显著相关性。
MEMS 测量的依从性与 ADHD 患者其他依从性测量方法存在差异。症状严重程度和改善水平与 MEMS 的依从性无关。需要进一步研究评估可能影响 ADHD 儿童药物依从性的变量。
