Martin Katherine B
Psychiatry, Lehigh Valley Health Network, Allentown, USA.
Cureus. 2020 Dec 2;12(12):e11847. doi: 10.7759/cureus.11847.
Many patients have uncontrolled psychiatric symptoms because they are not taking their medication as prescribed. Psychiatrists may have difficulty accurately assessing medication adherence, which is important because it helps guide them in how they prescribe. If nonadherence is the cause of uncontrolled symptoms, then strategies to improve adherence are advised. However, if nonadherence is not the cause, then the usual course of action would be to intensify or modify the medication regimen. Knowing whether nonadherence is a factor at the time of an appointment could help guide clinical decision making in real-time.
A cohort of established patients in an outpatient mental health treatment clinic at a large health network was studied from November 2018 to August 2019. Blood drug levels of several oral antipsychotic medications were obtained and placed in the following three categories: below, within, or above the therapeutic range of published cutoff points. Treating physicians answered Likert-scale questions regarding their assessment of patient adherence. Subsequently, blood drug levels were compared to the psychiatrists' assessment of adherence using a Kappa coefficient. Results: Sixty-four patients being prescribed antipsychotic medications were analyzed. A total of 87.5% of treating psychiatrists thought their patients were always adherent or adherent greater than 50% of the time. However, based on blood levels, 14% of the 42 patients at target FDA dosing for their medication and diagnosis were below the therapeutic range. The Kappa coefficient was used to find the level of agreement between the treating psychiatrist's perception of patient adherence and the blood drug level. It was determined to be 0.14 which is consistent with no agreement between the two measurements. Conclusions: Treating psychiatrists inaccurately estimated oral antipsychotic medication adherence based on clinical impression alone. Making an objective measure of adherence available at the time of an appointment could help psychiatrists recognize nonadherence in real-time and inform prescribing decisions.
许多患者的精神症状未得到控制，原因是他们未按医嘱服药。精神科医生可能难以准确评估药物依从性，而这很重要，因为它有助于指导医生如何开药。如果不依从是症状未得到控制的原因，那么建议采取提高依从性的策略。然而，如果不依从不是原因，那么通常的做法是强化或调整药物治疗方案。在预约就诊时了解不依从是否是一个因素，有助于实时指导临床决策。
对2018年11月至2019年8月在一个大型医疗网络的门诊心理健康治疗诊所的一批复诊患者进行了研究。获取了几种口服抗精神病药物的血药浓度，并将其分为以下三类：低于、处于或高于已公布截断点的治疗范围。治疗医生回答了关于他们对患者依从性评估的李克特量表问题。随后，使用卡帕系数将血药浓度与精神科医生对依从性的评估进行比较。
对64名正在服用抗精神病药物的患者进行了分析。共有87.5%的治疗精神科医生认为他们的患者总是依从或超过50%的时间依从。然而，根据血药浓度，在按美国食品药品监督管理局（FDA）目标剂量服药且诊断明确的42名患者中，14%低于治疗范围。使用卡帕系数来确定治疗精神科医生对患者依从性的认知与血药浓度之间的一致程度。结果确定为0.14，这表明这两种测量结果之间没有一致性。
治疗精神科医生仅根据临床印象对口服抗精神病药物的依从性估计不准确。在预约就诊时提供客观的依从性测量方法，有助于精神科医生实时识别不依从情况并为开药决策提供依据。
