Richey Anabel G, Kovacs Ildiko, Browne Sara
Department of Psychiatry, Oxford University, Oxford, United Kingdom.
Department of Medicine, University of California, San Diego, La jolla, CA, United States.
JMIR Ment Health. 2022 Dec 2;9(12):e39047. doi: 10.2196/39047.
Serious mental illness is a chronic condition that requires long-term pharmacological treatment. Adherence to oral antipsychotic medication has specific nuances that affects patients and physicians alike. For patients with serious mental illness, nonadherence increases their risk of hospitalization and relapse. Nonadherence is a formidable barrier for physicians in accurately assessing medication efficacy and helping patients achieve their fullest potential. A digital adherence system approved by the Food and Drug Administration can provide near-real time aripiprazole ingestion information. The system records ingestions through an embedded ingestible sensor in oral aripiprazole, which sends a transient local signal to a patch worn on the patient's torso that is then stored on a paired smartphone app. With patient permission, these data can be viewed remotely by their physician, along with a patient's mood, activity, and time spent resting. Such data are able to do the following: reveal broad patterns of medication adherence behavior to the patient as well as their physician; help physicians and patients understand and create more realistic expectations for adherence; promote discussion of treatment options; and minimize therapeutic appointment time devoted to determining actual adherence, thereby maximizing the time available to address each patient's distinctive reasons for their adherence pattern. Crucially, extra time created during appointments can be used to strengthen the therapeutic relationship, which may translate into both improvements in adherence and patient attitude toward their medication. Future investigations are needed to examine how this technology impacts the development of training and best practice guidelines for its use. Otherwise, the potential benefits of this technology may be lost, or worse, inadequate and inappropriate use may harm the therapeutic relationship.
严重精神疾病是一种需要长期药物治疗的慢性疾病。口服抗精神病药物的依从性有其特定的细微差别，对患者和医生都会产生影响。对于患有严重精神疾病的患者，不依从会增加他们住院和复发的风险。不依从对医生准确评估药物疗效以及帮助患者充分发挥潜力来说是一个巨大的障碍。一种经美国食品药品监督管理局批准的数字依从性系统可以提供近乎实时的阿立哌唑摄入信息。该系统通过口服阿立哌唑中嵌入的可摄入传感器记录摄入情况，该传感器会向佩戴在患者躯干上的贴片发送一个短暂的局部信号，然后该信号会存储在配对的智能手机应用程序上。在患者允许的情况下，医生可以远程查看这些数据，以及患者的情绪、活动和休息时间。这些数据能够做到以下几点：向患者及其医生揭示药物依从行为的广泛模式；帮助医生和患者理解并对依从性产生更现实的期望；促进对治疗方案的讨论；并尽量减少用于确定实际依从性的治疗预约时间，从而最大限度地利用可用时间来探讨每位患者依从模式的独特原因。至关重要的是，预约期间节省的额外时间可用于加强治疗关系，这可能会转化为依从性的提高以及患者对药物的态度改善。未来需要进行调查，以研究这项技术如何影响其使用的培训和最佳实践指南的制定。否则，这项技术的潜在益处可能会丧失，或者更糟的是，使用不当可能会损害治疗关系。
