title: Methodological challenges in psychiatric treatment adherence research.
abstract: Reflecting an increasing awareness of the importance of treatment adherence on outcomes in psychiatric populations, the National Institute of Mental Health (NIMH) convened a panel of treatment adherence researchers on September 27-28, 2007 to discuss and articulate potential solutions for dealing with methodological adherence research challenges. Panel discussions and presentations were augmented with targeted review of the literature on specific topics, with a focus on adherence to medication treatments in adults with serious mental illness. The group discussed three primary methodological areas: participants, measures, and interventions. When selecting patients for adherence-enhancing interventions (AEIs), a three-tier model was proposed that draws from the universal (targeting all patients receiving medication treatment for a specific condition, regardless of current adherence), selective (targeting patients at risk for nonadherence), and indicated (targeting patients who are currently nonadherent) prevention model and emphasizes careful patient characterization in relevant domains and appropriate matching of interventions to the selected population. Proposals were also made to reduce problematic selection biases in patient recruitment and retention. The panel addressed the pros and cons of various methods that can be used to measure adherence, and concluded that it is appropriate to use multiple measures whenever possible. Finally, the panel identified a broad range of intervention approaches, and conditions under which these interventions are likely to be most effective at reducing barriers to adherence and reinforcing adherence behavior.
authors.affiliation: Department of Psychiatry, Mail Stop 7797, The University of Texas Health Science Center, 7704 Floyd Curl Drive, San Antonio, TX 78229-3900, USA. velligand@uthscsa.edu
authors.forename: Dawn
authors.initials: D
authors.lastname: Velligan
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
authors.forename: William T
authors.initials: WT
authors.lastname: Riley
authors.forename: Steven
authors.initials: S
authors.lastname: Safren
authors.forename: Roberto
authors.initials: R
authors.lastname: Lewis-Fernandez
authors.forename: Peter
authors.initials: P
authors.lastname: Weiden
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
authors.forename: Julian
authors.initials: J
authors.lastname: Jamison
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D035843:Biomedical Research; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000523:psychology; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D012107:Research Design; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D015983:Selection Bias; D016903:Drug Monitoring
chemical_list: D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D011619:Psychotropic Drugs