双相情感障碍患者通过智能手机评估的药物依从性的有效性和特征：对MONARCA I和II试验汇总数据的探索性再分析
Validity and characteristics of patient-evaluated adherence to medication via smartphones in patients with bipolar disorder: exploratory reanalyses on pooled data from the MONARCA I and II trials.
作者信息
Faurholt-Jepsen Maria, Frost Mads, Christensen Ellen Margrethe, Bardram Jakob Eyvind, Vinberg Maj, Kessing Lars Vedel
机构信息
Psychiatric Center Copenhagen, Rigshospitalet, Department O. Copenhagen, Copenhagen, Denmark
Monsenso Aps, Copenhagen, Denmark.
出版信息
Evid Based Ment Health. 2020 Feb;23(1):2-7. doi: 10.1136/ebmental-2019-300106.
BACKGROUND
Non-adherence to medication is associated with increased risk of relapse in patients with bipolar disorder (BD).
OBJECTIVES
To (1) validate patient-evaluated adherence to medication measured via smartphones against validated adherence questionnaire; and (2) investigate characteristics for adherence to medication measured via smartphones.
METHODS
Patients with BD (n=117) evaluated adherence to medication daily for 6-9 months via smartphones. The Medication Adherence Rating Scale (MARS) and the Rogers' Empowerment questionnaires were filled out. The 17-item Hamilton Depression Rating Scale, the Young Mania Rating Scale and the Functional Assessment Short Test were clinically rated. Data were collected multiple times per patient. The present study represents exploratory pooled reanalyses of data collected as part of two randomised controlled trials.
FINDINGS
During the study 90.50% of the days were evaluated as 'medication taken', 6.91% as 'medication taken with changes' and 2.59% as 'medication not taken'. Adherence to medication measured via smartphones was valid compared with the MARS (B: -0.049, 95% CI -0.095 to -0.003, p=0.033). Younger age and longer illness duration were significant predictors for non-adherence to medication (model concerning age: B: 0.0039, 95% CI 0.00019 to 0.0076, p=0.040). Decreased affective symptoms measured with smartphone-based patient-reported mood and clinical ratings as well as decreased empowerment were associated with non-adherence.
CONCLUSIONS
Smartphone-based monitoring of adherence to medication was valid compared with validated adherence questionnaire. Younger age and longer illness duration were predictors for non-adherence. Increased empowerment was associated with adherence.
CLINICAL IMPLICATIONS
Using smartphones for empowerment of adherence using patient-reported measures may be helpful in everyday clinical settings.
TRIAL REGISTRATION NUMBER
NCT01446406 and NCT02221336.
背景
双相情感障碍（BD）患者不坚持服药与病情复发风险增加相关。
目的
（1）验证患者通过智能手机评估的服药依从性与经过验证的依从性问卷的一致性；（2）调查通过智能手机测量的服药依从性特征。
方法
117例双相情感障碍患者通过智能手机连续6 - 9个月每日评估服药依从性。填写药物治疗依从性评定量表（MARS）和罗杰斯赋权问卷。对17项汉密尔顿抑郁量表、杨氏躁狂量表和功能评估简短测试进行临床评分。每位患者多次收集数据。本研究是对作为两项随机对照试验一部分收集的数据进行的探索性汇总再分析。
结果
在研究期间，90.50%的天数被评估为“已服药”，6.91%为“有变化地服药”，2.59%为“未服药”。与MARS相比，通过智能手机测量的服药依从性是有效的（B： - 0.049，95%CI - 0.095至 - 0.003，p = 0.033）。年龄较小和病程较长是不服药的显著预测因素（年龄相关模型：B：0.0039，95%CI 0.00019至0.0076，p = 0.040）。基于智能手机的患者报告情绪和临床评分测量的情感症状减轻以及赋权降低与不服药相关。
结论
与经过验证的依从性问卷相比，基于智能手机的服药依从性监测是有效的。年龄较小和病程较长是不服药的预测因素。赋权增加与依从性相关。
临床意义
在日常临床环境中，使用智能手机通过患者报告的测量方法增强服药依从性可能会有所帮助。
试验注册号
NCT01446406和NCT02221336。
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