Integrated measures to prevent nonadherence underused in schizophrenia
medwireNews: German study results show that psychiatrists often underestimate treatment nonadherence in schizophrenia patients and that integrated care interventions to improve adherence are underused.
The main barriers to such interventions, as identified by the 121 physicians in the study, were limited resources, such as staff shortages, and organisational issues, such as a lack of proper discharge planning.
Prior research indicates that multimodal adherence-improving measures can improve medicine adherence, “including, for example, organizational, psychosocial, and behavioral interventions, as well as an increased use of depot medication”, explain Johannes Hamann (Technical University of Munich) and co-researchers.
Using at least 80% medicine taken as a marker of adherence in the current study, physicians judged that 53% of the approximate 213 participating inpatients with schizophrenia or schizoaffective disorder were adherent. Patients estimated this figure to be 40%.
Having “intensive talks” with patients was the most common measure reported by physicians to improve patients' adherence after discharge, at 29% compared with 16% for patient psychoeducation, 7% for intensified outpatient care and 1% for psychoeducation for relatives, among other measures.
Hamann and colleagues asked physicians about their use of four readily available core interventions: depot antipsychotic treatment, psychoeducation for patients and for relatives and the arrangement of a first outpatient follow-up visit. They reported that a respective 32%, 40%, 9% and 18% of participants received these.
Among those who reported not using these interventions, a raft of reasons were given. The most common per intervention was the belief that patients had good adherence to an oral drug in the case of depot prescription (33% believed this), a lack of available groups in the case of psychoeducation of patients and relatives (35 and 25%, respectively) and not knowing the specific discharge day in the case of arranging follow-up appointments (40%).
“[M]any physicians responded that more resources and a better organizational structure in the hospitals were needed to facilitate the implementation of adherence measures”, remark Hamann et al in Psychiatric Services.
The team suggests that “a structured appraisal of the patients' adherence (including objective measures such as plasma levels) might help physicians to become more aware of this problem.”
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By Sarah Pritchard, medwireNews Reporter