Medication Preferences and Adherence Among Individuals With Severe Mental Illness and Psychiatric Advance Directives

Abstract

Objective Psychiatric advance directives allow patients with severe mental illness to document their preferences for particular medications. This study investigated the role of psychiatric advance directives in treatment choice and medication adherence. Methods A total of 123 persons with severe mental illness recorded medication preferences in psychiatric advance directives. The authors compared medication preferences to prescribed medications over 12 months, determined concordance between preferred and prescribed medications, and examined the effect of concordance on medication adherence at 12 months. Results Participants requested a median of two medications in their psychiatric advance directives (range, zero to six) and refused a median of one medication (range, zero to ten). At follow-up, the number of medications requested in psychiatric advance directives that were currently prescribed increased by 27%. (Wilcoxon matched pairs, p<.001). After correcting for the number of medications listed in the psychiatric advance directive, a 10% increase in concordance remained significant (p<.001). Being prescribed at least one medication requested in the psychiatric advance directive predicted higher medication adherence at 12 months, after the analysis controlled for relevant covariates (odds ratio=7.8, 95% confidence interval=1.8–34.0). Conclusions Providing information about medication preferences in psychiatric advance directives may increase prescribing of patient-preferred medications even in noncrisis settings. Patients who were prescribed medications that they request in advance were significantly more likely to adhere to medications, supporting the benefit of patient participation in medication choice. Psychiatric advance directives appear to be a clinically useful conduit for communicating patient medication preferences.

An exploratory study of the role of trust in medication management within mental health services

“…A lack of choice was disempowering and could increase the risk associated with medication, and due to the reciprocal nature of trust, damaged service users' trust and adherence-particularly if specific concerns were ignored [18]. Not all service users felt that there was a lack of choice.…”

“…Safe medication management and improved adherence may be most effectively achieved by policies and practices which adopt a partnership, rather than a coercive, approach and focus on trust rather than risk. A good example of a strategy, which adopted a partnership approach, involved the use of advance directives in people with severe mental illness [18]. Adherence at 12 months was higher amongst service users, who were prescribed at least one medication requested in an advance directive (odds ratio = 7.8, 95% confidence interval 1.8-34.0) [18].…”

“…A good example of a strategy, which adopted a partnership approach, involved the use of advance directives in people with severe mental illness [18]. Adherence at 12 months was higher amongst service users, who were prescribed at least one medication requested in an advance directive (odds ratio = 7.8, 95% confidence interval 1.8-34.0) [18]. Therefore, orienting services around trust may reduce risk by creating virtuous circles of compliance rather than vicious circles of non-compliance [5].…”

Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies

“…The clinician needs to listen to the patient, understand their perspective, including their beliefs and concerns about their illness and medication, and ensure that their preferences regarding treatment are based on fact rather than misperceptions. Involving patients in the choice of their medication increases the likelihood of adherence 84,85. The amount of information required will vary between patients.…”

Anwendung psychiatrischer Behandlungsvereinbarungen in Deutschland

“…Zwar ist die Evidenz bezüglich unterschiedlicher klinischer Outcomeparameter noch gering, da es nur wenig Studien gibt, die den Abschluss einer BV als Intervention untersucht haben [7]. Weitere mittlerweile veröffentlichte randomisiertkontrollierte Studien zeigen aber eine Reduktion von Zwangsmaßnahmen [18] und eine verbesserte Adhärenz in Bezug auf die Psychopharmakotherapie [19]. Außerdem scheinen BV auch aus der Sicht der Betroffenen dazu beizutragen, dass diese die von ihnen bevorzugte Therapie in einer Krise erhalten [10].…”