Risk Factors For Poor Adherence Research Articles

Adherence to vitamin D supplementation and determinant factors during the first year of life

Breastfed infants under one year of age may not get enough vitamin D; therefore a vitamin supplement is needed. The adherence to this policy has not yet been evaluated in Chile. To evaluate the adherence to vitamin D supplementation in children less than one year old and the determinant factors involved. A cross-sectional study was carried out in three Catholic University Health Network centers. Breastfed infants under one year of age were included in the study. Their parents/guardians filled out a questionnaire about adherence to supplementation and its determinant factors. 170 infants were recruited. 164 of them received supplementation, with a good adherence of 68.9%. The main reason for non-adherence was due to maternal forgetfulness. The identified risk factor for poor adherence was the number of maternal children. Vitamin D supplementation in Chile reaches high levels, but its adherence is poor. More education to parents on ways to avoid forgetting the supplement is needed as well as on identifying risk factors during medical consultations.

Antiretroviral therapy adherence monitoring and its impact on immuno-virological outcome

One of the most important factors in achieving a good outcome is treatment adherence. Poor adherence to antiretroviral therapy (ART) leads to less viral suppression, permanent treatment resistance and increased costs. There are multiple causes of poor adherence: regimen complexity, side effects etc. Aim: to analyze ART adherence, risk factors for poor adherence and their impact on the outcome. We performed a one year survey (from January to December 2013) of HIV infected patients monitored in the Third Department of the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”. The data (number of days covered by ART) was collected from patients’ files. We correlated the adherence with gender, regimen rank and complexity. Statistical analysis was made using EPI INFO 6. We retrospectively analyzed 111 patients who came in to our clinic monthly to pick-up their ART, 52 women (46.84%) and 59 men (53.16%) with a mean age of 43.5 years old. The adherence to ART was: 23 (20.62%) – 100% adherence, 36 (32.43%) – more than 96.7% adherence (less than 12 days without medication), 38 (34.23%) – 91.8% to 96.7% adherence (13-30 days without medication), 10 (9%) – 83.6% to 91.8% adherence (30-60 days without medication) and 4 (3.6%) with less than 83.6% adherence (more than 60 days without medication). The level of adherence was correlated with therapeutic failure: for 100% adherence – two failures (8.69%), for more than 96.7% adherence – no failure, for more than 91.8% adherence – 4 failures (11.1%), for more than 83.6% adherence – 2 failures (20%) and for less than 80% adherence – 3 failures (75%). Adherence below 91.8% was correlated with treatment failure: RR 5.65 (CI95% 1.99; 16.09, p=0.0007). We analyzed some possible risk factors for poor adherence: gender, regimen rank and complexity. Although 51.95% from the non-adherence group were women, the adherence wasn’t correlated with gender: RR 1.23 (CI95% 0.93; 1.62, p=0.16). A regimen rank higher than 1 was correlated with low adherence – 45.76% vs. 28.84% in the adherence vs. non-adherence group: RR 1.5 (CI95% 0.95; 2.38, p=0.07). The regimen containing protease inhibitors wasn’t correlated with low adherence: 33.9% vs. 30.8%, RR 1.08 (CI95% 0.71; 1.67, p=0.73). We emphasize the impact of therapy adherence on the outcome. A level of adherence below 91% was correlated with therapeutic failure. ART adherence wasn’t correlated with gender, PI regimen and rank regimen.

Patient adherence to tyrosine kinase inhibitor therapy in chronic myeloid leukemia

Dramatically improved survival associated with tyrosine kinase inhibitor (TKI) therapy has transformed the disease model for chronic myeloid leukemia (CML) to one of long-term management, but treatment success is challenged with poor medication adherence. Many risk factors associated with poor adherence can be ameliorated by close monitoring, dose modification, and supportive care. Controlling risk factors for poor adherence in combination with patient education that includes direct communication between the health care team and the patient are essential components for maximizing the benefits of TKI therapy.

Adherence to isoniazid preventive therapy in Indonesian children: A quantitative and qualitative investigation.

BackgroundIt is recommended that young child contacts of sputum smear positive tuberculosis cases receive isoniazid preventive therapy (IPT) but reported adherence is low and risk factors for poor adherence in children are largely unknown.MethodsWe prospectively determined rates of IPT adherence in children < 5 yrs in an Indonesian lung clinic. Possible risk factors for poor adherence, defined as ≤3 months prescription collection, were calculated using logistic regression. To further investigate adherence barriers in-depth interviews were conducted with caregivers of children with good and poor adherence.ResultsEighty-two children eligible for IPT were included, 61 (74.4%) of which had poor adherence. High transport costs (OR 3.3, 95% CI 1.1-10.2) and medication costs (OR 20.0, 95% CI 2.7-414.5) were significantly associated with poor adherence in univariate analysis. Access, medication barriers, disease and health service experience and caregiver TB and IPT knowledge and beliefs were found to be important determinants of adherence in qualitative analysis.ConclusionAdherence to IPT in this setting in Indonesia is extremely low and may result from a combination of financial, knowledge, health service and medication related barriers. Successful reduction of childhood TB urgently requires evidence-based interventions that address poor adherence to IPT.

Lopinavir/Ritonavir-based Antiretroviral Therapy in Human Immunodeficiency Virus Type 1-infected Naive Children

Lopinavir/ritonavir (LPV/r) is now the protease inhibitor regimen of choice in the first-line antiretroviral therapy for children <6 years of age. We included all the human immunodeficiency virus (HIV) type 1-infected highly active antiretroviral therapy (HAART)-naive children who started an LPV/r-based regimen between 2000 and 2009 at the Necker Hospital (Paris, France). Virologic failure (VF) was defined as an HIV-RNA ≥50 copies/mL. Resistance genotypic test was performed in case of VF. A total of 43 children were included at a median age of 4.8 years (1.8-8.0). Median level of HIV RNA and percentage of CD4 cell count was 5.5 log₁₀ copies/mL (4.6-6) and 15% (8-27.5), respectively. HAART included LPV/r and 2 nucleoside reverse-transcriptase inhibitors, mainly lamivudine (3TC), zidovudine, and/or abacavir. The median follow-up period was 36 months (18-72). Less than 50 copies/mL of HIV RNA was observed in 46%, 67%, and 70% of the children at months 6, 9, and 12, respectively. In all, 20 children (46.5%) experienced a VF. The risk factors of primary VF were a young age and a low socioeconomic status. The genotypic resistance test, performed for 18 of 20 children with VF, revealed 1 LPV/r-resistant virus and protease inhibitor-related major mutations without LPV/r resistance in 2 other children. Of the 18 children with VF, 15 received a 3TC-based HAART: 12 of 15 (80%) harbored a 3TC-resistant virus. No virus resistant to zidovudine or abacavir was found. In all, 70% of HAART-naive children had virologic success at month 12. The selection of LPV-resistant strains was a rare event. A high rate of selection of 3TC-mutations strengthens the recommendation to prefer a first-line 3TC-sparing regimen, particularly for children with risk factors of poor adherence.

Adherence to hand hygiene and risk factors for poor adherence in 13 Ontario acute care hospitals

Multicenter studies assessing hand hygiene adherence and risk factors for poor performance are scarce. In an observational study involving 13 hospitals across Ontario, Canada, we found a mean adherence rate of 31.2%, and that adherence was positively associatedwith nurses, single rooms, contact precautions, and the availability of alcohol hand rub dispensers.

Medical, Psychological, and Sociodemographic Factors Associated With Adherence to Cardiac Rehabilitation Programs

Cardiac rehabilitation (CR) programs have been shown to reduce mortality and morbidity rates among coronary heart disease patients, but adherence to these classes has been found to be poor. This review aims to summarize and integrate research findings investigating the possible sociodemographic, medical, and psychological variables that influence patient adherence to CR programs. It also aims to address the methodological failings of past reviews conducted in this area. Several databases were systematically searched for studies published between 1990 and 2009. Studies examining CR program adherence or completion, using data based on participant's actual recorded attendance were included. Eighteen studies were identified that met inclusion criteria. Low mood, participant's age, and certain cardiac risk factors were found to be most consistently associated with poor adherence to CR. A good understanding of the consequences of heart disease was found to be associated with good adherence. Results were relatively inconsistent across studies because of differences in methods used. Certain risk factors for poor adherence to CR should be assessed and monitored by health professionals. Future studies should address the methodological difficulties present in previous research. Recommendations are made for standardizing methods in future research.

The impact of comorbidity on medication adherence and therapeutic goals

IntroductionPrescribing medications is often challenging in olderpeople with multiple chronic diseases. Non-adherenceto prescribed medications is among the most importantproblems, so that many people are not benefiting prop-erly from the drugs they are prescribed. Additionally,this also represents a costly waste for health services [1].Comorbidity and medication adherencePoor adherence to the prescribed therapy is highly pre-valent in older patients. Prevailing evidence suggeststhat age per se should not be considered as a risk factorfor poor adherence [2]. Lower educational level, lessaffluent economic status, cognitive/physical impairment,being assisted by foreign caregivers, and some chronicdiseases, such as chronic renal failure, are commonlyreported poorly modifiable correlates of non-adherence.Regimen complexity represents a to some extent modifi-able correlate [2]. Vision impairment, reduced manualdexterity, and patients’ perception of medication impor-tance may contribute to determine the relationshipbetween regimen complexity and non-adherence. Thereis minimal evidence to support interventions thatimprove medication adherence, and the effects of psy-chosocial interventions are largely unknown [1].Therapeutic goals in patients with multiplechronic conditionsPatients with multiple chronic conditions may vary inregard to their opinion about health outcomes such aslonger survival, prevention of disease-specific events,physical and cognitive function, and tolerable risk ofadverse drug reactions. A paradigmatic example of howchallenging this issue can be in clinical practice is thedifficulty in rational prescribing for older patients withmultiple chronic conditions and reduced life expectancy,when the likelihood of benefit and goals of care mustalso be considered in addition to satisfying the basicprinciples of optimal medication use in the elderly [3].

Is there an association between neurocognitive performance and medication adherence in first episode psychosis?

Medication adherence is a determining factor for symptomatic remission and relapse prevention following a first episode of psychosis (FEP). Neurocognitive abilities have received only scant attention so far as a risk factor for poor adherence but significant impairments with memory and/or planning abilities could play a role. We examined early medication adherence following admission to a specialized clinical programme for FEP. One hundred sixty FEP participants and 35 healthy controls completed an exhaustive neurocognitive assessment. FEP participants were categorized as a function of their medication adherence at 6 months into poor (n = 34), partial (n = 27) and full (n = 99) adherence, respectively. Domain-specific and global measures of cognitive ability were examined. No measure of neurocognition could significantly discriminate amongst the three medication adherence groups. These results suggest no strong associations between neurocognitive abilities and medication adherence in first episode of psychosis.

Reciprocal prediction of medication adherence and neurocognition in HIV/AIDS

Antiretroviral medications have been shown to benefit neurocognition in HIV/AIDS, and neurocognitive deficits are a risk factor for poor adherence to these medications. However, little is known about the predictive pathways linking medication adherence with cognitive ability. In the current 6-month cohort study, antiretroviral medication adherence was tracked prospectively among 91 HIV-positive adults using electronic monitoring. Comprehensive neuropsychological evaluations were performed at baseline and 6 months. Multivariate path analyses provided evidence that antiretroviral adherence and cognitive ability are reciprocally related, although the neurocognitive pathways of this relationship appear to vary by predictive direction. Executive function and learning/memory were most strongly predictive of levels of medication adherence achieved, whereas higher levels of adherence were predictive of relative improvements in a wide range of frontostriatal brain functions including processing speed, attention, executive functions, and motor functioning. These data provide evidence that cognition and adherence are reciprocally related in HIV/AIDS. In particular, executive dysfunction may play a key role in this relationship. Interventions aimed at improving or preserving executive functions could hold promise for interrupting progressive declines in adherence and neurocognitive ability in HIV/AIDS.

Early Medication Adherence and Insight Change in First-Episode Psychosis

Objective: Adherence to treatment is a determining factor for symptomatic remission and relapse prevention following a first episode of psychosis (FEP). Risk factors for poor adherence have consistently involved a lack of insight. While insight can improve considerably during the first months of treatment, little is known about the relation between early change in insight and medication adherence. Method: Eighty-eight FEP participants were rated on insight and positive, negative, depressive, and anxious symptoms at baseline and at six months following admission. Insight was measured with the Scale to assess Unawareness of Mental Disorder. FEP participants were categorized as a function of their medication adherence at six months into poor (n=16), partial (n=11) and full-adherence (n=61) groups. Results: No significant group differences in insight emerged at baseline. However, at six months, the poor-adherence group displayed worse insight relative to the partial-adherence group, while the full-adherence g...

A Comprehensive Perspective on Patient Adherence to Topical Glaucoma Therapy

Risk factors for poor adherence or nonadherence to topical glaucoma medication regimens. Poor adherence to glaucoma medication regimens may be associated with subsequent visual loss and irreversible optic nerve damage. A literature search was performed using the words "glaucoma AND adherence AND risk" and "glaucoma AND compliance AND risk," limited to those studies in English and focused on care in the United States. Publications from well-regarded journals in this field were reviewed, and a focused summary of the literature is presented. There are a myriad of adherence barriers inherent to the glaucoma patient population. Although most of these obstacles are common in the elderly (e.g., reduced cognition, musculoskeletal problems, and transportation difficulties), older age has not been shown to be a consistent risk factor for poor adherence to glaucoma medication regimens. Other expected barriers, such as medication cost, limited health insurance, disease severity, and role of complicated dosing regimens, have varied effects based on the patient population studied and the definition of adherence. Poor medication adherence also is associated with decreased adherence to follow-up medical visit schedules. A systematic taxonomy of adherence barriers has been formulated. In addition, subanalyses from the Glaucoma Adherence and Persistency Study identified 8 variables that affect adherence to glaucoma medication regimens as well as several characteristics that support the importance of and associations between doctor-patient communications. Recent studies have provided valuable insights into the many factors that increase the risk(s) for poor adherence in patients prescribed glaucoma medications. Four major types of barriers to effective patient adherence (medication regimen, patient factors, provider factors, and situational or environmental factors) have been identified. Addressing these specific barriers will require a tailored, patient-centered approach. Proprietary or commercial disclosure may be found after the references.

A prospective study of cannabis use as a risk factor for non-adherence and treatment dropout in first-episode schizophrenia

IntroductionAlthough several studies have reported on cannabis use and adherence for first episode of psychosis patients, the findings remain unclear as to whether cannabis use is a risk factor for poor adherence in young people with first-episode schizophrenia. This study was designed to follow patients' use of cannabis and adherence in a naturalistic setting during the first 12 months of treatment. It examines whether cannabis use is a risk factor for two distinct types of non-adherence: non-adherence to medication and treatment dropout. MethodsParticipants were 112 first-episode schizophrenia patients of diverse backgrounds at two community hospitals, enrolled in a study of differential effectiveness of two second-generation antipsychotic medications. Multiple indicators were used to assess cannabis use and adherence to medication. Patients were encouraged to continue in the study even after periods of treatment refusal or change from study to standardized medication. Study hypotheses were tested using Cox proportional hazards models with cannabis use as a time-varying covariate. ResultsAfter 12 months, 23 had dropped out and 37 had at some point been non-adherent to medication. Of 34 participants who used cannabis during treatment, 32 had a prior diagnosis of cannabis abuse/dependence and 30 were male. Independently of age, race, socioeconomic status, gender, site, and medication assignment, cannabis use significantly increased hazard of non-adherence by a factor of 2.4 (p<.001) and hazard of dropout by a factor of 6.4 (p=.034). ConclusionResults indicate that cannabis use is a risk factor for non-adherence to medication and dropout from treatment. Treatment for first-episode schizophrenia may be more effective if providers address the issue of cannabis use with patients throughout the early years of treatment, especially for those with existing cannabis abuse/dependence.

Risk Factors for Poor Adherence to Eyedrops in Electronically Monitored Patients with Glaucoma

To identify risk factors for poor adherence to topical once daily therapy for glaucoma. Prospective, observational cohort study. A total of 196 patients with glaucoma who were being treated with a prostaglandin analog in 1 or more eyes at the Scheie or Wilmer Eye Institutes between August 2006 and June 2007. Demographics, ocular history, and responses to interview questions about glaucoma knowledge, health beliefs, and drop-taking behaviors were obtained from each patient. All patients used the Travatan Dosing Aid (DA; Alcon Laboratories Inc., Fort Worth, TX) to administer travoprost as prescribed. Devices were collected at 3 months, and the data of drop use were downloaded using software provided with the DA. Patients taking <or=75% doses during the 8-week period starting 2 weeks after the enrollment visit and ending 2 weeks before the 3-month visit were compared with those taking >75% of doses. Risk factors for poor adherence. Eighty-seven patients (44.4% of the 196 subjects with evaluable data at 3 months) used the DA on 75% or less of the monitored days. In univariate analysis, poorer adherers were more likely to be <50 or >or=80 years of age, to be African American, to report less than excellent health, to report higher amounts of depression, to have lower income, and to be treated at the Scheie Eye Institute. Multivariate analysis (adjusting for education and income) found that age, race/ethnicity, and less than excellent health were associated with poor adherence. Those who failed to take more than 75% of eyedrop doses were more likely to be African American and to report poor health. Those in the youngest and oldest age groups were less adherent, although this finding was not always statistically significant. Further research into the factors driving these associations and into developing predictive models to assist in screening for low adherence are warranted. Proprietary or commercial disclosure may be found after the references.

Patterns of Individual and Population-Level Adherence to Antiretroviral Therapy and Risk Factors for Poor Adherence in the First Year of the DART Trial in Uganda and Zimbabwe

Good adherence is essential for successful antiretroviral therapy (ART) provision, but simple measures have rarely been validated in Africa. This was an observational analysis of an open multicenter randomized HIV/AIDS management trial in Uganda and Zimbabwe. At 4-weekly clinic visits, ART drugs were provided and adherence measured through pill usage and questionnaire. Viral load response was assessed in a subset of patients. Drug possession ratio (percentage of drugs taken between visits) defined complete (100%) and good (>or=95%) adherence. In 2,957 patients, 90% had pill counts at every visit. Good adherence increased from 87%, 4 weeks after ART initiation, to 94% at 48 weeks, but only 1,454 (49%) patients achieved good adherence at every visit in the first year. Complete adherence was associated with 0.32 greater reduction in log10 viral load (95% confidence interval 0.05, 0.60 P = 0.02) and was independently associated with higher baseline CD4 count, starting ART later in the trial, reporting a single regular sexual partner, clinical center, and time on ART. Population level adherence improved over time suggesting an association with clinical experience. Most patients had at least one visit in the year on which they reported not having good adherence, showing the need for continued adherence interventions.

Ethnic differences in primary angle-closure glaucoma

Observational studies from different countries have shown that populations of East Asian origin have a higher frequency of primary angle-closure glaucoma compared with those of European or African descent. As half of all cases of glaucoma reside in Asia, and with primary angle-closure glaucoma carrying a higher rate of visual morbidity, primary angle-closure glaucoma poses an important public health problem; however, the inconsistent use of techniques and definitions to detect and diagnose primary angle-closure glaucoma has resulted in difficulties in interpreting the accuracy and comparability of such data. Therefore it is important to review these studies in the light of a consistent classification system. There are increasing reports that support previous findings on the incidence and prevalence of primary angle-closure glaucoma in different ethnic groups. There have also been further investigations into the mechanism and natural history of primary angle-closure glaucoma in Asian populations. International investigations into primary angle-closure glaucoma have demonstrated reproducible evidence that ethnic variations do exist. Cross-sectional studies in this area have also suggested that differences in anterior chamber depth, together with its association with peripheral anterior synechiae, may be part of the underlying mechanism behind these differences. The ideas generated need to be further explored with longitudinal data of changes in anterior chamber depth and peripheral anterior synechiae in different populations. The detailed mechanisms behind the development of angle-closure and primary angle-closure glaucoma should also be investigated.

Predicting Treatment Adherence in Obstructive Sleep Apnea Using Principles of Behavior Change

To determine the relative predictive utility of measures of behavior-change principles on treatment adherence in individuals with obstructive sleep apnea. Ninety-eight participants with moderate to severe obstructive sleep apnea were recruited into this prospective longitudinal study. Participants were recruited from an academic sleep disorders center after having completed in-lab polysomnography and before initiating continuous positive airway pressure (CPAP) therapy. Participants were all treatment naive. Measurements of behavior-change principles were taken at baseline and periodically throughout the 6-month follow-up. Adherence, measured by the amount of nightly use at the proper pressure, was monitored covertly by the CPAP machines. Measures from 2 behavior-change theories (Transtheoretical Model and Social Cognitive Theory) were used in this study: readiness to change, perceived self-efficacy, and decisional balance. The results from the present study suggest that measures of behavior change predict CPAP adherence at 6 months posttreatment when assessed at 1 week and at 3 months posttreatment. When these measures are assessed at baseline, however, they are not predictive of CPAP use at 6-months. These measures do not improve upon the prediction of 6-month adherence provided by previous adherence. While the readiness, decisional balance, and self-efficacy measures were all predictive of adherence, the strongest predictive utility came from measures of readiness and self-efficacy. Those individuals who use CPAP more were more likely to rate themselves as ready and confident in their ability to use CPAP. The utility of these measures was diminished when controlling for previous use. Our intention, however, was to study modifiable risk factors for poor adherence. Principles of behavior change, which are often used in adherence research in other medical populations, are thought to be modifiable with behavioral interventions and show promise for improving adherence.

Assessing associations between medication adherence and potentially modifiable psychosocial variables in pediatric kidney transplant recipients and their families

Post-transplant immunosuppressant (IS) medication adherence is essential for long-term graft survival and relatively little is known about psychosocial barriers that interfere with optimum medication adherence in pediatric kidney transplant patients. The objective of this prospective observational cohort study was to assess the impact of modifiable psychosocial variables on medication adherence. Our hypothesis was that parental stress, dysfunctional parent-child interactions and child behavior problems would be associated with poorer medication adherence. Thirteen pediatric kidney transplant patients and their caregivers were enrolled. Transplant recipients who were able to read and caregivers of all the transplant recipients completed behavioral and attitudinal surveys. A subgroup of seven families dispensed their primary IS medication from an electronic monitoring vial (MEMS Smart Cap). For these patients, medication adherence was calculated by computing a ratio of the medication taken divided by the prescribed dose. In addition, for the entire group, serial IS levels were reviewed by two board certified pediatric nephrologists who categorized all 13 transplant recipient families as either 'probably adherent (PA)' or 'possibly non-adherent (PNA)'. Pearson correlation coefficients and independent samples Student t-tests were used to assess the association between medication adherence and psychosocial variables measured by standardized questionnaires. In this study, elevated parental stress, dysfunctional parent-child interactions, and child behavior problems were associated with poorer medication adherence. In addition, we found evidence to support the relationship between subjective dissatisfaction with appearance and poorer medication adherence. These findings suggest that pre-transplant recipient evaluations of risk factors for poor adherence are warranted.

Effectiveness of a hospital-wide programme to improve compliance with hand hygiene

Hand hygiene prevents cross infection in hospitals, but compliance with recommended instructions is commonly poor. We attempted to promote hand hygiene by implementing a hospital-wide programme, with special emphasis on bedside, alcohol-based hand disinfection. We measured nosocomial infections in parallel. We monitored the overall compliance with hand hygiene during routine patient care in a teaching hospital in Geneva, Switzerland, before and during implementation of a hand-hygiene campaign. Seven hospital-wide observational surveys were done twice yearly from December, 1994, to December, 1997. Secondary outcome measures were nosocomial infection rates, attack rates of methicillin-resistant Staphylococcus aureus (MRSA), and consumption of handrub disinfectant. We observed more than 20,000 opportunities for hand hygiene. Compliance improved progressively from 48% in 1994, to 66% in 1997 (p<0.001). Although recourse to handwashing with soap and water remained stable, frequency of hand disinfection substantially increased during the study period (p<0.001). This result was unchanged after adjustment for known risk factors of poor adherence. Hand hygiene improved significantly among nurses and nursing assistants, but remained poor among doctors. During the same period, overall nosocomial infection decreased (prevalence of 16.9% in 1994 to 9.9% in 1998; p=0.04), MRSA transmission rates decreased (2.16 to 0.93 episodes per 10,000 patient-days; p<0.001), and the consumption of alcohol-based handrub solution increased from 3.5 to 15.4 L per 1000 patient-days between 1993 and 1998 (p<0.001). The campaign produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction of nosocomial infections and MRSA transmission. The promotion of bedside, antiseptic handrubs largely contributed to the increase in compliance.

Interactive risk factors for treatment adherence in a chronic psychotic disorders population

This study identified the unique and primary contributions of several concurrent risk factors for poor adherence to treatment recommendations in a clinic population of individuals with chronic psychotic disorders, i.e. 48% had DSM-IV diagnoses of schizoaffective disorder, 38% had schizophrenia, paranoid type, 12% had schizophrenia, undifferentiated type, and 2% had affective disorder with psychotic features. The target cohort consisted of 87 consecutive admissions to a continuing day treatment program. As part of a services-oriented quality assurance program, clinical staff completed rating scales for all patients. These included the BASIS-32 rating scale, which consisted of the following five subscales: psychosis; depression/anxiety; impulsive/addictive behavior; relation to self and others; and daily living and role functioning, and the Working Alliance Inventory-short form (therapist version), which consisted of the following three subscales: goal; task; and bond. These data were used to identify risk factors that weaken a patient’s adherence to medication and non-medication treatment during the first 2 weeks of treatment in the clinic. Medication treatment consisted of both typical and atypical neuroleptic medications, with most patients being on multiple medications. Correlational analyses suggested that many of the risk factor variables were significantly associated with poor treatment adherence. Regression analyses suggested that the degree of psychoticism was most strongly associated with poor adherence to medication treatment and that difficulties relating to self and others were the strongest predictor of poor adherence to non-medication treatment. A large-sample services research design such as this can begin to determine patterns of associations between previous identified risk factors and poor treatment adherence in individuals with chronic psychotic disorders.