A Review of Factors Relating to Medication Non-Adherence in Patients with Schizophrenia (original) (raw)
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Medication adherence in schizophrenia
World Journal of Psychiatry, 2012
Non-adherence is a major problem in the treatment of schizophrenia. Its high prevalence, potentially severe consequences and associated costs make the study of this phenomenon a priority issue. In this article, basic non-adherence concepts of prevalence, consequences, evaluation methods, methodological restrictions of available studies, risk factors and intervention strategies, are reviewed. Studying non-adherence risk factors is a necessary step toward designing adequately oriented intervention strategies. An operative definition of adherence and good knowledge of its evaluation methods are essential to study this phenomenon. Unfortunately, most available studies contain methodological restrictions, especially concerning the evaluation methods, and an agreed operative definition of adherence has only very recently been reached. Knowing non-adherence risk factors, intervention strategies and available evidence on their effectiveness is essential in making treatment decisions in daily clinical practice.
Treatment Non-Compliance in Patients with Schizophrenia
Journal of Universal College of Medical Sciences
INTRODUCTION: Non-compliance to medication in Schizophrenia is a common problem. It leads to frequent recurrence of Psychosis which has negative impact on individuals and their families. Understanding and reducing non-adherence is therefore a key challenge to quality care for patients with Schizophrenia. This study was conducted with the aim of determining the incidence and factors associated with medication non-compliance among patients suffering from schizophrenia. MATERIAL AND METHODS: This cross-sectional study included 94 schizophrenic subjects who visited psychiatric OPD of tertiary level hospital. Disproportionate stratified random sampling method was applied to collect the data. Socio-demographic data sheet, data sheet to collect the various factors of compliance and the 8-item Morisky Medication Adherence Scale (MMAS-8) were used for data collection by interview method. RESULTS: The prevalence of non-compliance was 89.4%. With regards to association between noncompliance ...
Prescription Patterns of Psychotropic Drugs and Non-Adherence in Patients with Schizophrenia
Journal of Medical Science And clinical Research, 2016
Context-Polypharmacy, rational or irrational, in psychiatry is a common phenomenon. One needs to understand various clinical and pharmaco-socioeconomic factors associated to deal with it. Non adherence to treatment in schizophrenia leads to relapse, hospitalizations, increased cost of treatment and therapeutic failure. Complexity of treatment decreases adherence. It is important to understand relation between polypharmacy and adherence. Aims and objectives-To find out prevalence of polypharmacy, most common causes of polypharmacy, level of medication adherence and correlation between polypharmacy and medication adherence in patients with schizophrenia Settings and Methodology-A total of 277 consecutive diagnosed patients with schizophrenia were included in the study. Their latest prescriptions were studied to find out rate of polypharmacy and most common reasons for doing so. Patients were asked to answer Morisky 8-item medication adherence scale, a valid and reliable measure of self reported adherence. Obtained data was analyzed statistically. Statistical analysis and Results-About 74 % of the patients received polypharmacy vs. 26 % received monotherapy. Three most common reasons for polypharmacy were to prevent adverse effects, to treat comorbidity and for augmentation. Polypharmacy did not have any association with age, sex, but polypharmacy had significant association with duration of illness. 36.5 % had low adherence, 21.7 % had high adherence while 41.9 % had medium adherence to prescribed regimen. Adherence did not show statistically significant association with age and sex but had significant association with total number drugs prescribed and duration of illness but failed to show any particular pattern. Conclusions-Polypharmacy is common practice in patients with schizophrenia at our centre and most common reason for it was to prevent adverse effects of primary drug, which is a justified indication. Adherence is a complex phenomenon, not related to factors such as age, sex but had association with duration of illness and total number of drugs prescribed. Most of our patients had medium adherence on MMAS. Polypharmacy did not have any significant effect on adherence across all age groups. Multiple complex factors influence polypharmacy and adherence in patients with schizophrenia like psycho-education, illness related factors and patient related factors. Probably rational polypharmacy is need of time.
Factors affecting medication adherence among adults with schizophrenia: A literature review
Archives of Psychiatric Nursing, 2016
Background and objective: Patient's adherence is an important factor affecting the successful maintenance of treatment, slow progression of the disease; reduce costs of health care especially in the presence of multiple chronic conditions as rheumatic disorders. While, medication non-adherence is a significant problem leads to increased mortality and morbidity. So, identification of the factors affecting non-adherence to medication regimens is beneficial for healthcare providers to improve patient's health condition. The aim of the study was to determine factors affecting medication adherence among sample of Egyptian patients with rheumatic disorders. Methods: Design: An exploratory descriptive research design. Subjects: Purposive sampling of patients with history of rheumatic disorders. Setting: The study was carried out in rheumatology department and medical wards at Al-Kaser Al-Aini hospital. Tool: Patient Preliminary Informational Variables, Morisky Medication Adherence Scale 8-Items and Factors affecting drug adherence checklist were used to collect pertinent data. Results: The study showed 59.2% of study group had low adherence, followed by medium adherence and high adherence (28%, 12.7%) to prescribed medications respectively. Findings also; revealed that the highest percent of these factors that may combine to render patients to be less able to adhere to prescribed medication ranked as complexity of medication regimen; chronic conditions, restricted formularies, changing medications covered on formularies; fear of possible adverse effects, fear of dependence; lack of continuity of care, treatment interferes with lifestyle or requires significant behavioral changes; patient information materials written at too high literacy level; severity of symptoms; lack of knowledge on adherence and the effective interventions for improving it; as well the medication cost; long wait times; burdensome schedule; poor access or missed appointments; actual or perceived unpleasant side effects; duration of therapy; medication negative effect on liver and kidney; in addition, psychosocial stress, anxiety and anger. Conclusions: Due to the diversity of causes of non-adherence, the health care professionals must understand factors affecting medication adherence when dealing with problems of medication adherence especially with chronic conditions as rheumatic disorders. Recommendation: Interventions for overcoming factors affecting adherence must become a central component of efforts to improve patients' health worldwide. This could be done by proper determination for factors affecting medication adherence, also to consider patient condition individually and modify the treatment approach accordingly.
Interventions to Improve Medication Adherence in People with Schizophrenia: A Systematic Review
Patient Preference and Adherence, 2022
Nonadherence to medications is very common in people with schizophrenia. Numerous methods have been implemented to improve medication adherence. The study aimed to determine what interventions have been used and to assess the effectiveness of these in improving medication adherence in people with schizophrenia. Two electronic databases (PubMed and Science Direct) and a manual search were used to locate RCT studies that examined interventions in medication adherence for schizophrenia, published between 2011 and 2022. The search was conducted using the terms (schizophrenia OR schizophrenic) AND (interventions OR adherence therapy) AND (medication adherence OR medication compliance). Sixteen studies were included, and relevant data were extracted and selected. Sixteen studies used interventions that involve family, health professionals (psychiatrists, psychologists, nurses, and pharmacists), SMS, and smart electronic reminders. Medication adherence was measured using medication refill records from hospital dispensing records or claim databases, electronic devices, plasma blood concentration, and participant self-reporting. Thirteen out of 15 studies showed significant improvements in adherence compared to routine care. The other three studies did not result in improved medication adherence. Interventions with diverse strategies delivered to individuals with schizophrenia showed the potential to reduce medication non-adherence in people with schizophrenia so that they can be utilized as an alternative to support treatment in people with schizophrenia in addition to antipsychotic medication. In future research strategies, it will be necessary to identify the main problems regarding nonadherence in people with schizophrenia individually and also identify the patient's perception of medication, illness, and behavior when taking medication in order to determine the next intervention that will be appropriate based on the patient's needs to improve adherence.
Determinants of medication compliance in schizophrenia
Schizophrenia Bulletin, 1997
Advances in psychopharmacology have produced medications with substantial efficacy in the treatment of positive and negative symptoms of schizophrenia and the prevention of relapse or symptom exacerba-
Patient Preference and Adherence, 2013
Background: Nonadherence is common among patients with schizophrenia, although the rates vary according to means of assessment and patient population. Failure to adhere to medication can have a major impact on the course of illness and treatment outcomes, including increasing the risk of relapse and rehospitalization. Understanding psychiatrists' perception of the causes and consequences of nonadherence is crucial to addressing adherence problems effectively. Methods: The Europe, the Middle East, and Africa (EMEA) Spanish Adherencia Terapéutica en la Esquizofrenia (ADHES) survey was conducted by questionnaire during January-March 2010 among psychiatrists treating patients with schizophrenia in 36 countries. The survey comprised 20 questions. In addition to recording the demographic details of the 4722 respondents (∼12% response rate), it canvassed their preferred methods of assessing adherence, their perceptions of adherence rates, reasons for nonadherence, and strategies to improve adherence. Results: Psychiatrists estimated that 53% of their patients with schizophrenia were partially/ nonadherent during the previous month. They estimated only one-third of patients who deteriorated after stopping medication were able to attribute this to nonadherence. Psychiatrists assessed adherence most often by patient interview. Lack of insight was viewed as the most important cause of medication discontinuation, followed by patients feeling better and thinking their medication unnecessary, and experiencing undesirable side effects. Considerably fewer psychiatrists viewed insufficient efficacy, cognitive impairment, or drug/alcohol abuse as the most important reasons for their patients stopping medication. Conclusion: Psychiatrists throughout EMEA recognize the impact of partial/nonadherence to medication, with patient enquiry being the most commonly used means of assessment. There remains a need for more proactive management of patients with schizophrenia, particularly in increasing patient insight of their illness in order to improve adherence and minimize the consequences of relapse. Strategies focused on raising awareness of the importance of adherence are also warranted, with the aim of improving patient outcomes in schizophrenia.
Psychiatry Research, 2010
To assess baseline predictors and consequences of antipsychotic adherence during the long-term treatment of schizophrenia outpatients, data were taken from the 3-year, prospective, observational, European Schizophrenia Outpatients Health Outcomes (SOHO) study, in which outpatients starting or changing antipsychotics were assessed every 6 months. Physician-rated adherence was dichotomized as adherence/ non-adherence. Regression models tested for predictors of adherence during follow-up, and associations between adherence and outcome measures. Of the 6731 patients analysed, 71.2% were adherent and 28.8% were non-adherent over 3 years. The strongest predictor of adherence was adherence in the month before baseline assessment. Other baseline predictors of adherence included initial treatment for schizophrenia and greater social activities. Baseline predictors of non-adherence were alcohol dependence and substance abuse in the previous month, hospitalization in the previous 6 months, independent housing and the presence of hostility. Non-adherence was significantly associated with an increased risk of relapse, hospitalization and suicide attempts. In conclusion, non-adherence is common but can partly be predicted. This may allow strategies to improve adherence to be targeted to high-risk patients. Also, reversal of some risk factors may improve adherence. Non-adherence is associated with a range of poorer long-term outcomes, with clinical and economic implications.