caa a22 4500 445321032 CHVBK 20180317142704.0 cr unu---uuuuu 170323e20110301xx s 000 0 eng 10.1007/s10488-010-0304-1 doi (NATIONALLICENCE)springer-10.1007/s10488-010-0304-1 Medication Adherence, Ethnicity, and the Influence of Multiple Psychosocial and Financial Barriers [Elektronische Daten] [John Zeber, Alexander Miller, Laurel Copeland, John McCarthy, Kara Zivin, Marcia Valenstein, Devra Greenwald, Amy Kilbourne] Medication adherence is critical for patients with bipolar disorder to avoid symptom exacerbation and diminished quality of life. Most analyses consider adherence barriers individually rather than conjointly, while neglecting potential ethnic differences. 435 patients in the Continuous Improvement for Veterans in Care--Mood Disorders study reported multiple financial and psychosocial factors influencing adherence. Logistic regression modeled adherence as a function of perceived barriers, including cost burden, access, binge drinking, poor therapeutic alliance, and medication beliefs. Nearly half the cohort experienced adherence difficulty, averaging 2.8 barriers, with minority veterans reporting lower adherence than white patients, particularly financial burden and treatment access. Total barriers were significantly associated with worse adherence (OR=1.24 per barrier), notably poor medication beliefs, binge drinking, and difficulty accessing psychiatric specialists (ORs of 2.41, 1.95 and 1.73, respectively). Veterans with bipolar disorder experience numerous adherence barriers, with certain obstacles proving especially pernicious. Fortunately tailored clinical interventions can improve adherence, particularly by addressing modifiable risk factors. Department of Veterans Affairs, 2010 Medication adherence nationallicence Psychosocial barriers nationallicence Ethnicity nationallicence Bipolar disorder nationallicence Veterans nationallicence Zeber John Veterans Affairs HSR&D: South Texas Veterans Health Care System (VERDICT), 7400 Merton Minter Boulevard (VERDICT 11c6), 78229-4404, San Antonio, TX, USA aut Miller Alexander Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA aut Copeland Laurel Veterans Affairs HSR&D: South Texas Veterans Health Care System (VERDICT), 7400 Merton Minter Boulevard (VERDICT 11c6), 78229-4404, San Antonio, TX, USA aut McCarthy John VA Ann Arbor Healthcare System, Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI, USA aut Zivin Kara VA Ann Arbor Healthcare System, Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI, USA aut Valenstein Marcia VA Ann Arbor Healthcare System, Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI, USA aut Greenwald Devra Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA aut Kilbourne Amy VA Ann Arbor Healthcare System, Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI, USA aut Administration and Policy in Mental Health and Mental Health Services Research Springer US; http://www.springer-ny.com 38/2(2011-03-01), 86-95 0894-587X 38:2<86 2011 38 10488 https://doi.org/10.1007/s10488-010-0304-1 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10488-010-0304-1 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Zeber John Veterans Affairs HSR&D: South Texas Veterans Health Care System (VERDICT), 7400 Merton Minter Boulevard (VERDICT 11c6), 78229-4404, San Antonio, TX, USA aut NATIONALLICENCE 700 1- Miller Alexander Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA aut NATIONALLICENCE 700 1- Copeland Laurel Veterans Affairs HSR&D: South Texas Veterans Health Care System (VERDICT), 7400 Merton Minter Boulevard (VERDICT 11c6), 78229-4404, San Antonio, TX, USA aut NATIONALLICENCE 700 1- McCarthy John VA Ann Arbor Healthcare System, Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Zivin Kara VA Ann Arbor Healthcare System, Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Valenstein Marcia VA Ann Arbor Healthcare System, Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI, USA aut NATIONALLICENCE 700 1- Greenwald Devra Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA aut NATIONALLICENCE 700 1- Kilbourne Amy VA Ann Arbor Healthcare System, Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI, USA aut NATIONALLICENCE 773 0- Administration and Policy in Mental Health and Mental Health Services Research Springer US; http://www.springer-ny.com 38/2(2011-03-01), 86-95 0894-587X 38:2<86 2011 38 10488 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer