title: Factors that affect adherence to bipolar disorder treatments: a stated-preference approach.
abstract: BACKGROUND
  Medication nonadherence is high among patients with bipolar disorder, and may lead to poor clinical outcomes, decreased quality of life, and increased resource utilization.
  
  
  OBJECTIVE
  To investigate the factors associated with nonadherence and to assess the effect of patient-stated preferences on stated adherence to hypothetical medications.
  
  
  METHODS
  A choice-format stated-preference Web survey was administered. In each choice question, patients were asked to choose among 2 or 3 different hypothetical medications. Each choice question was followed by a question asking patients about their likely adherence to the selected medication alternative.
  
  
  METHODS
  Patients (N = 469) with self-reported bipolar disorder completed the survey which was programmed and administered to members of a chronic-illness Web panel.
  
  
  METHODS
  Factors associated with stated adherence to current treatment were identified. The effects of socioeconomic characteristics and medication attributes on stated adherence to hypothetical medications were assessed.
  
  
  RESULTS
  Patient socioeconomic characteristics affect patients' adherence. Being white and having more education has a significant positive effect on adherence. Self-reported current adherence is a strong factor in predicting adherence for better medications. Medication outcome attributes, especially severity of depressive episodes, strongly influence patients' stated adherence to treatment. Weight gain and cognitive effects of a medication most significantly affected patients' likely adherence to medications for bipolar disorder.
  
  
  CONCLUSIONS
  Patients are the final health care decision makers; their satisfaction with a medication is likely to affect whether or not they adhere to the medication prescribed by their physician. In the case of bipolar disorder, this study suggests patients are likely to be more adherent to medications that reduce the severity of depressive episodes and do not cause weight gain or cognitive side effects. By understanding the factors that improve adherence, health care providers can optimize prescribing patterns, which may ultimately lead to more effective management and improvement in the patient's condition.
authors.affiliation: RTI Health Solutions, North Carolina, USA. frjohnson@rti.org
authors.forename: F Reed
authors.initials: FR
authors.lastname: Johnson
authors.forename: Semra
authors.initials: S
authors.lastname: Ozdemir
authors.forename: Ranjani
authors.initials: R
authors.lastname: Manjunath
authors.forename: A Brett
authors.initials: AB
authors.lastname: Hauber
authors.forename: Steven P
authors.initials: SP
authors.lastname: Burch
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Thompson
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D003072:Cognition Disorders / Q000139:chemically induced; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance; D017060:Patient Satisfaction; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000494:pharmacology; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D015430:Weight Gain
chemical_list: D011619:Psychotropic Drugs