The Effect of Objectively Collected Medication Adherence Information on Bipolar I and Major Depressive Disorder Treatment Decisions: A Randomized Case Vignette Study of Psychiatric Clinicians (Preprint)

Abstract

Adherence to antipsychotic medications is critical for treatment and relapse prevention in serious mental illness. Accurate assessment of medication adherence can be difficult, and clinicians frequently overestimate patient adherence. Newly available digital medicine technologies can objectively assess patient medication adherence and share the data with clinicians.

To estimate the influence of objectively collected antipsychotic medication adherence information on clinician treatment decisions among patients with bipolar (BD) and major depressive (MDD) disorders.

This study was a cross-sectional two-group random assignment survey of psychiatric clinicians who prescribe antipsychotic medication in the treatment of BD and/or MDD. Clinicians (N=180) were recruited using national association lists. Respondents were presented with five simulated patient case summaries (vignettes) each presenting descriptions of symptoms, level of functioning, and self-reported medication adherence. Clinicians were presented with either BD or MDD vignettes and were randomly assigned to vignettes that presented subjective (self-report) or objective adherence information. For each vignette, respondents were asked to recommend adjustments in medication.

A total of 180 clinicians participated. Those who were asked to make decision on care of BD (N=90) were more likely to modify antipsychotic treatment as opposed to mood stabilizers. Clinicians who were asked to make care decision of MDD patients (N=90) were more likely to modify antidepressant treatment as opposed to antipsychotic prescriptions. Among vignettes indicating non-adherence, reports derived from objective adherence data increased recommendations to adopt long-acting injectable antipsychotics though the rate of LAI choice overall was greater for BD vs. MDD.

Objective adherence data helps clinicians distinguish between medication non-adherence and medication non-response, thus allowing them to make more informed treatment decisions. These data suggest that the presence of objective adherence data will influence clinicians’ prescribing patterns as illustrated by their recommendations to modify antipsychotic medication prescriptions for patients with BD and to a lesser degree those with MDD.