Are there any reliable techniques to assess antipsychotic medication adherence?

As you are probably aware, partial adherence and non-adherence to antipsychotics is common and contributes to poor outcomes in this population of patients. Researchers have estimated that improving antipsychotic medication adherence among patients with schizophrenia could save $1,600 per person per year in Medicaid and criminal justice costs. In an examination of 161 studies, patient self-report of adherence was found to be very inaccurate and clinician estimates were not much better! However, since 2003 there have been urine testing technologies that simultaneously detect illicit substances as well as ingested medications and estimate levels of certain antipsychotic medications. These technologies include confirmatory tests that use gas chromatography-mass spectrometry to specify which drugs and metabolites are present in the urine. Reference ranges are calculated, and these are highly correlated with serum levels that indicate the degree of medication adherence. Results are available within a few days.

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