Assessment of Clinician Awareness of Nonadherence Using a New Structured Rating Scale

Introduction. Lack of adherence to prescribed antipsychotic medication is recognized as a leading reason for poor outcomes and symptomatic relapse among patients with schizophrenia. There is evidence, however, that treating clinicians are often either unaware that their patients are not taking their medication or overestimate their adherence. Methods. A structured instrument, the Medication Adherence Assessment Tool (MAAT), was developed by an expert group of clinicians convened and sponsored by Ortho-McNeil Janssen Scientific Affairs, LLC. Clinicians were asked to use the MAAT to rate the degree of adherence among a group of their patients who were prescribed antipsychotic medications. We compared the results of the MAAT evaluation with a validated, indirect measure of treatment adherence derived from pharmacy data, the medication possession ratio (MPR). Results. Although the MAAT has good internal reliability, we found that MAAT scores were not significantly correlated with MPR. Conclusion. These findings suggest that, even when using a structured instrument, clinicians are unable to accurately assess the degree of treatment adherence among patients prescribed antipsychotic medications. Informing clinicians as to measures of medication possession, such as the MPR, appears to be a low-cost, minimally intrusive, and effective way to improve clinician assessment of patient adherence and thereby overall clinical outcomes. (Journal of Psychiatric Practice 2010; 16: 164-169)