Clin Psychopharmacol Neurosci 2019; 17(2): 288-296  
Medication Adherence Using Electronic Monitoring in Severe Psychiatric Illness: 4 and 24 Weeks after Discharge
Yujin Lee, Moon-Soo Lee, Hyun-Ghang Jeong, Hyun-Chul Youn, Seung-hyun Kim
Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
Correspondence to: Seung-hyun Kim, MD, PhD Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea
Tel: +82-2-2626-1243, Fax: +82-2-852-1937 E-mail: shyun@korea.ac.kr
ORCID: https://orcid.org/0000-0002-2189-4600
Received: September 7, 2018; Revised: October 9, 2018; Accepted: September 10, 2018; Published online: May 31, 2019.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective: The purpose of this study was to examine post-hospitalization outpatient drug adherence in patients with severe psychiatric illness, including bipolar disorder and schizophrenia, and to investigate factors associated with drug adherence.
Methods: Eighty-one patients diagnosed with schizophrenia or bipolar disorder who were hospitalized due to aggravation of psychiatric symptoms were monitored. At hospitalization, we conducted clinical assessments such as the Clinical Global Impression-Severity, Drug Attitude Inventory, Contour Drawing Rating Scale, Multidimensional Scale of Perceived Social Support scale, and patients’ demographic factors. We measured drug adherence using the Medication Event Monitoring System (MEMS), pill count, and patients’ self-report upon out-patients visits, 4 and 24 weeks after discharge.
Results: The mean values of the various measures of adherence were as follows: MEMS (4 weeks) 84.8%, pill count (4 weeks) 94.6%, self-report (4 weeks) 92.6%, MEMS (24 weeks) 81.6%, pill count (24 weeks) 90.6%, and self-report (24 weeks) 93.6%. The adherence agreement between MEMS, pill count, and self-report was moderate (4 weeks intraclass correlation [ICC]=0.54, 24 weeks ICC=0.52). Non-adherence (MEMS ≤0.08) was observed in 26.4% of the patients at 4 weeks and 37.7% at 24 weeks. There was a negative correlation between drug adherence assessed 4 weeks after discharge and Contour Drawing Rating Scale difference score (r=−0.282, p<0.05). A positive correlation was found between drug adherence assessed 24 weeks after discharge and Drug Attitude Inventory (r=0.383, p<0.01).
Conclusion: Patients’ attitude towards their medication and their degree of physical dissatisfaction influenced post-hospitalization drug adherence in severe psychiatric patients.
Keywords: Adherence; Schizophrenia; Bipolar disorder; Medication Event Monitoring System; Drug monitoring.


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