Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

Abstract

PurposeIn patients with schizophrenia, nonadherence to prescribed medications increases the risk of patient relapse and hospitalization, key contributors to the costs associated with treatment. The objectives of this review were to evaluate the impact of nonadherence to pharmacotherapy in patients with schizophrenia as it relates to health care professionals, particularly social workers, and to identify effective team approaches to supporting patients based on studies assessing implementation of assertive community treatment teams.Materials and methodsA systematic review of the medical literature was conducted by searching the Scopus database to identify articles associated with treatment adherence in patients with schizophrenia. Articles included were published from January 1, 2003, through July 15, 2013, were written in English, and reported findings concerning any and all aspects of nonadherence to prescribed treatment in patients with schizophrenia.ResultsOf 92 unique articles identified and formally screened, 47 met the inclusion criteria for the systematic review. The burden of nonadherence in schizophrenia is significant. Factors with the potential to affect adherence include antipsychotic drug class and formulation, patient-specific factors, and family/social support system. There is inconclusive evidence suggesting superior adherence with an atypical versus typical antipsychotic or with a long-acting injectable versus an oral formulation. Patient-specific factors that contribute to adherence include awareness/denial of illness, cognitive issues, stigma associated with taking medication, substance abuse, access to health care, employment/poverty, and insurance status. Lack of social or family support may adversely affect adherence, necessitating the assistance of health care professionals, such as social workers. Evidence supports the concept that an enhanced team-oriented approach to managing patients with schizophrenia improves adherence and supports corresponding reductions in relapse rates, inpatient admissions, and associated costs.ConclusionOptimization of medication and involvement of caregivers are important to promoting adherence. A multidisciplinary team approach may be invaluable in identifying barriers to adherence and helping schizophrenia patients overcome them.

Treatment compliance and noncompliance in psychoses

“…[1543] In this study, there was no difference between the two groups with respect to distance to the hospital or transportation charges. Thus, these factors may not distinguish between compliance and noncompliance.…”

Physician and patient benefit–risk preferences from two randomized long-acting injectable antipsychotic trials

“…Detailed descriptions of the two trials have been published 20,21. These surveys were adapted from versions used in pilot studies conducted with patients and physicians sampled from online panels 18,19…”

Post-discharge medication adherence in schizophrenia

“…In addition, adherence rates vary over time, even in the same individual [1]. Despite the view that medication adherence in schizophrenia is high after hospital discharge, the transition to home-based treatment may be complicated, especially for those individuals who lack family or social support [12]. Weiden et al [13], in a large observational study of patients with schizophrenia, found that almost half of the prescription gaps occurred in the first 50 days after starting a second-generation antipsychotic.…”