Assessment of adherence to oral antipsychotic medications: What has changed over the past decade?

INTRODUCTION: In a previous review, spanning 3 decades, we found that self-report and other non-objective measures were the primary means of assessing adherence to oral antipsychotic medications for individuals with schizophrenia. Moreover, consensus regarding the definition of adherence was completely lacking. Here, we examined the next decade of studies to determine what may have changed. METHOD: We searched the peer reviewed literature published between January 1, 2007 and December 31, 2017 using Google scholar, Science Direct, CINAHL, PsychINFO, PsychARTICLES and Medline. Search terms were medication adherence or medication compliance or medication acceptance or medication follow-through or medication concordance or medication persistence AND schizophrenia. We included articles that assessed adherence behavior. RESULTS: The search yielded 663 articles, 363 of these were eliminated. Included studies represent over 560,000 individuals. Definitions of adherence remain variable with cutoffs from 67% to 95%. Subjective measures of adherence remain the most commonly used. However, the use of objective measures has significantly increased, as has the use of electronic claims data. However, the absolute number of studies using objective measures remains low and very few approaches identify the amount of medication actually taken. CONCLUSIONS: Some movement toward more standardization and the use of more objective measures of adherence has been made over the past decade. However, objective measures continue to be underutilized and definitions remain variable. Assessing adherence in less than optimal ways calls into question the results of studies purporting to identify reasons for problem adherence and to elucidate the relationships among adherence and other variables.

Hemodialysis access success: beyond the operating room.

BACKGROUND: Publication of the Kidney Disease Outcomes Quality Initiative (KDOQI) Guidelines has reinforced an already increased focus within the Veterans Health Administration (VHA) on arteriovenous (AV) hemodialysis (HD) vascular access. Meeting these KDOQI goals has been the responsibility of individual VHA centers. We responded by organizing a dedicated HD AV clinic to provide preoperative evaluation and postoperative follow-up. METHODS: The records of 130 patients referred from January 2004 through June 2006 to our AV HD clinic were retrospectively reviewed. A minimum of 6 months of postoperative follow-up was required. RESULTS: AV fistulae were performed in 71% of the patients, with approximately 45% being Brescia-Cimino fistulae. Importantly, only 38% of AV fistulae matured and were used without secondary intervention. The remaining 62% of AV fistulae each required 2.2 +/- .3 interventions. The final AV fistula use rate was approximately 85%. CONCLUSIONS: To meet these KDOQI guidelines, the VHA should continue to support the concept of dedicated AV HD teams and clinics. This is essential because the majority of our new AV fistulae required secondary intervention for AV fistulae maturation and use. A dedicated HD access team should better be able to assess AV fistula maturation and organize subsequent intervention to promote AV fistulae use.