Industrial Psychiatry Journal (Jan 2023)

Detecting medication non-adherence in schizophrenia: A comparison of different methods among outpatients from a North Indian center

  • Nidhi Chauhan,
  • Subho Chakrabarti,
  • Sandeep Grover

DOI
https://doi.org/10.4103/ipj.ipj_147_22
Journal volume & issue
Vol. 32, no. 2
pp. 380 – 389

Abstract

Read online

Background: The rates of medication non-adherence among Indian patients with schizophrenia are high, and its detection poses problems. Comparisons of suitable measures to detect medication non-adherence in schizophrenia from Indian outpatient settings are scarce. Aim: This study compared simple and inexpensive methods of detecting medication non-adherence in schizophrenia among outpatients from a tertiary-care center in North India. Materials and Method: A longitudinal comparison of two self-reports, the Morisky Medication Adherence Questionnaire and the Drug Attitude Inventory-10, clinicians' ratings employing the Compliance Rating Scale, and clinic-based pill counts was conducted among 70 outpatients with schizophrenia. The rates and detection of medication non-adherence, associations with determinants of treatment non-adherence, and agreement between measures were examined at intake and after six months of follow-up (n = 53). Results: The self-reports had greater ability to detect medication adherence (specificity 41–65%; positive predictive values 25–51%; negative likelihood ratios 0.86–1.14) and moderate ability to detect medication non-adherence (sensitivity 27–65%; negative predictive values 49–69%; positive likelihood ratios 0.78–1.10). They yielded higher medication non-adherence rates, detected changes in medication non-adherence over time, and were associated with the other measures and the well-known correlates of medication non-adherence. Clinicians' ratings and pill counts had high sensitivity (56–90%) but low specificity (35–49%) to detect medication non-adherence. Conclusion: Self-reports are comparatively better screening options for detecting medication non-adherence among Indian outpatients with schizophrenia. However, the sequential use of different measures could lead to better recognition of medication non-adherence.

Keywords