Practical Approach to Measuring and Predicting Medication Adherence by Outpatient's SelfReport After More than 10 Years of Research in Psychopharmacology

Abstract

Schizophrenia, bipolar disorder and major depression are associated with nonadherence registered mean fi gures of around 50%, highlighting the relevance of having simple adherence tools to incorporate into daily clinical practice. For 10 years we have focused on self-report as an assessment method and have studied thousands of outpatients taking thousands of psychiatric medications in three countries. Measurement of treatment adherence during use of polypharmacy is a really complex task as patients could adhere diff erently to the various medications prescribed, making it essential to assess adherence to each individual medication. This was not possible until the introduction of the Sidorkiewicz Adherence Tool that allows one to separate adherence to each medication, whether poor or not. Health psychologists have developed the Health Belief Model which has not received enough attention by psychiatrists. Based on this model, we have focused on personality styles and specifi c beliefs concerning specifi c medications as possible predictors of poor adherence. We developed the Patient Health Beliefs Questionnaire on Psychiatric Treatment which provides 5 self-reported personality dimensions: negative aspects of medication (pharmacophobia), positive aspects of medication (pharmacophilia), high/low psychological reactance, high/low doctor health locus of control (HLOC) and high/low internal HLOC. Based on the Beliefs about Medicines Questionnaire we have developed a measure of skepticism, defi ned as a patient’s high concern about adverse reaction to an individual medication and a low belief in its necessity. Our research experience based on the tools for assessing and predicting adherence is presented in a practical manner by using seven boxes and examples.