Effect of necessity‐concern framework and polypharmacy on treatment adherence in psychiatric patients. Comparing an Argentinian with a Spanish sample

Abstract

Objective We aimed to replicate a prior Spanish study of medication adherence where logistic regression models provided highly significant odds ratios (ORs) for three continuous scores: necessity, concern and the necessity‐concern differential, and a dichotomous variable: skeptical attitude. Adherence ORs in the necessity‐concern framework were very strong in patients taking five or six medications. Methods The sample comprised consecutive adult psychiatric outpatients in Mendoza, Argentina. The necessity‐concerns framework was assessed using a subscale of the Beliefs about Medicines Questionnaire. Adherence (yes/no) to prescribed psychiatric medications was assessed by the Sidorkiewicz adherence tool. Results When compared with the Spanish sample, the Argentinian group (508 patients with 875 medications) was characterized by: (1) significantly stronger adherence ORs with the necessity‐concern framework, (2) significantly lower number of medications per patient and percentage of patients with marked psychiatric polypharmacy (≥4 medications), (3) though a higher number of medications still was significantly associated with poor adherence. Conclusions The Argentinian sample replicated the previous finding that patient beliefs regarding necessity and concern were associated with poor adherence to prescribed medications. Polypharmacy had an additive role decreasing adherence in both samples. In both samples, when prescribed ≥4 psychiatric medications, patients reported adherence to only two‐third of the medications.

Psychiatric Patients’ Perceived Health Control and Reactance: Implications for Medication Adherence

“…The PHBQ-PT has been used in various studies to assess health beliefs and treatment adherence in patients with psychiatric disorders, including depression, bipolar disorder, and schizophrenia. [47][48][49][50][51] Overall, the PHBQ-PT is a useful tool for assessing health beliefs and treatment adherence in patients with psychiatric disorders, and can help healthcare providers tailor their approach to treatment to improve patient outcomes.…”

Mortality and Lithium-Protective Effects after First-Episode Mania Diagnosis in Bipolar Disorder: A Nationwide Retrospective Cohort Study in Taiwan

“…Therefore, the related result shall be explained as a lower mortality rate for lithium users compared to non-lithium users. Conversely, drug exposure in this study was determined using prescription records, which introduced a confounding factor due to possible patient non-adherence [ 65 ]. For example, non-adherent patients might be mistakenly classified as lithium users.…”

Implications of psychological reactance for clinical practice in psychiatry including a systematic review.

“…As described in footnote a of Table 1, 10 of the 32 articles were excluded (Allen et al, 1994; Cho et al, 2016; Cunningham et al, 2020; Ho et al, 2005; Lee et al, 2021; Longshore & Teruya, 2006; Soveri et al, 2020; Taboada-Vázquez et al, 2021; Taylor & Asmundson, 2021; Zimbres et al, 2020). The 22 included articles were five written by other authors (Jaeger, 2015; McNiel et al, 2013; Moore et al, 2000; Pogany & Lazary, 2021; Pogany et al, 2022) and 17 written by at least one of the two authors of this article (De Las Cuevas, 2023; De Las Cuevas & de Leon, 2017, 2019, 2020; De Las Cuevas & Peñate, 2015a, 2015b; De Las Cuevas, Baptista, et al, 2021; De Las Cuevas et al, 2016, 2017; De Las Cuevas, Lazary, et al, 2021; De Las Cuevas, Motuca, et al, 2021; De Las Cuevas, Peñate, & Sanz, 2014; De Las Cuevas, Villasante-Tezanos, et al, 2021; Lara-Cabrera et al, 2020; Lazary et al, 2021; Mundal et al, 2021; Pogany et al, 2021). Three scales were used to measure psychological reactance (De Las Cuevas & de Leon, 2020; Dowd et al, 1991; Hong, 1992).…”