A review of behavioral tailoring strategies for improving medication adherence in serious mental illness

Abstract

Nonadherence to psychopharmacological treatments poses a significant challenge to treatment success in individuals with serious mental illness, with upwards of 60% of people not taking their psychiatric medications as prescribed. Nonadherence is associated with adverse outcomes, including exacerbation of psychiatric symptoms, impaired functioning, increased hospitalizations and emergency room use, and increased health care costs. Whereas interventions using psychoeducation or cognitive approaches, such as motivational interviewing, have largely proven ineffective in improving adherence, approaches employing behavioral tailoring that incorporate medication taking into the daily routine and/or use environmental supports have shown promise. Recently, adherence-enhancing behavioral tailoring interventions that utilize novel technologies, such as electronic monitors and mobile phones, have been developed. Although interventions utilizing these platforms have the potential for widespread dissemination to a broad range of individuals, most require further empirical testing. This paper reviews selected behavioral tailoring strategies that aim to improve medication adherence and other functional outcomes among individuals with serious mental illness.

Predicting Recovery in Individuals With Serious Mental Illness: Expanding the International Classification of Functioning, Disability, and Health (ICF) Framework

“…Psychotropic medications are established first-line treatment for controlling psychiatric symptoms (Stern et al, 2018); however, nonadherence to prescriptions is common among people with SMI and the leading cause of relapse in mental illness (Barkhof et al, 2012). Systematic and meta-analytic research evidence supports the use of psychoeducation (Zhao et al, 2015), motivational interviewing (Wong-Anuchit et al, 2018), and behavioral strategies (Kreyenbuhl et al, 2016) to improve medication adherence for people with SMI.…”

analytical review on schizophrenia pharmaceutical treatment along with intelligent retrieval

“…Unstructured weekly phone calls from nurses to 847 outpatients with schizophrenia were shown to improve treatment compliance and attitudes regarding medication. There was a 97% increase in investigator-rated treatment compliance over TAU after the intervention across at least four months (Kreyenbuhl et al, 2016). Using the MARS questionnaire, 140 outpatients with schizophrenia failed to show a meaningful improvement after two months of treatment (Beebe et al, 2016).…”

“…To help individuals with schizophrenia take their medication on a daily basis when previous psychosocial therapies had had uneven or inconclusive outcomes, numerous individually designed behavioural techniques were devised (Clifford et al, 2020;Kreyenbuhl et al, 2016;Gray et al, 2016). There are a number of treatments that may be used in conjunction with these tactics, including reminders from pharmacies, financial or other reinforcements, computerised monitoring and apps for mobile phones (Table 3) (Kreyenbuhl et al, 2016;Montes et al, 2010;Granholm et al, 2012;Montes et al, 2012;Velligan et al, 2013;Beebe et al, 2014;Beebe et al, 2016;Dahan et al, 2016;Beebe et al, 2017;Kidd et al, 2018;Xu et al, 2019;Uslu & Buldukoglu, 2020). A professional therapist visits the patient's house every week for 30 to 45 minutes for PharmCAT, whereas Cognitive Adaptation Training (CAT) employs visual aids such as signs, labels, and checklists to help patients remember to take their medication.…”

“…If clinicians in responsive and supportive clinical care systems have a good therapeutic relationship with their patients and their families are engaged, they may help them adhere to their treatment programmes (Sendt & Tracy et al,2015). There are also a variety of technological approaches that may help patients stick to their medication regimen, including medication trackers, missed-dose alerts, activity check lists and frequent phone calls from their doctor or pharmacist, all of which will be explored further on in this article (Barkhof & Meijer, 2012;Kreyenbuhl & Record et al, 2016). Early research assistance has been supported by a number of programmes, although these efforts have not been well explored (Clifford & Crabb et al, 2020;Fleischhacker, 2013;Ostuzzi & Mazzi et al, 2018;Higashi K, Medic G et al, 2013;Czobor & Van Dorn et al, 2015).…”

Treatment Compliance Communications Between Patients with Severe Mental Illness and Treating Healthcare Providers: A Retrospective Study of Documentation Using Healthcare Reimbursement Claims and Medical Chart Abstraction

“…28 Yet, assessing adherence during outpatient care is difficult. 27 Data are scarce describing dialogues regarding compliance with antipsychotic medication or other treatments. 15 The purpose of this study was to describe the frequency and circumstances of communications between providers and patients regarding treatment compliance among patients with symptomatic SMI.…”