Attitudes regarding the collaborative practice model and treatment adherence among individuals with bipolar disorder

Abstract

An emerging literature suggests that a collaborative care model, in which patients are active managers of their illness within a supportive social environment, is a beneficial approach for individuals with bipolar disorder. One aspect of treatment that is often suboptimal among individuals with bipolar disorder is treatment adherence. Establishing an ideal collaborative model may offer an opportunity to enhance treatment adherence among individuals with bipolar disorder. This paper presents results from a qualitative exploration of patients' attitudes towards the collaborative care model and how individuals with bipolar disorder perceive treatment adherence within the context of the collaborative care model. All participants were actively enrolled in outpatient treatment at a Community Mental Health Center and part of a larger study that evaluated the Life Goals Program, a manual-driven structured group psychotherapy for bipolar disorder that is based on the collaborative practice model. The Life Goals Program is designed to assist individuals to participate more effectively in the management of their bipolar illness and to improve their social and work-related problems. Individuals were queried regarding their opinions on the ingredients for an effective client-provider relationship. Quantitative data were collected on baseline treatment adherence as well. Individuals treated for bipolar disorder in a community mental health clinic identified 12 key elements that they felt were critical ingredients to a positive collaborative experience with their mental health care provider. The authors conceptualized these elements around 3 emerging themes: patient-centered qualities, provider-centered qualities, and interactional qualities. Individuals with bipolar disorder perceived the ideal collaborative model as one in which the individual has specific responsibilities such as coming to appointments and sharing information, whereas the provider likewise has specific responsibilities such as keeping abreast of current "state-of-the-arf" prescribing practices and being a good listener. Treatment adherence was identified as a self-managed responsibility within the larger context of the collaborative model. Individuals with bipolar disorder in this study placed substantial emphasis on the interactional component within the patient-provider relationship, particularly with respect to times when the individual may be more symptomatic and more impaired. It is important that clinicians and care providers gather information related to patients' perceptions of the patient-provider relationship when designing or evaluating services aimed at enhancing treatment adherence.

Psychotropic Medication Nonadherence Among United States Latinos: A Comprehensive Literature Review

“…As previously noted in several papers (82, 89, 90), and suggested by the findings of two studies in this review (41, 56), even clinics with primarily bilingual, bicultural staff can have cultural divides with their patients due to socioeconomic and health models and beliefs differences. Recognizing those divides and working collaboratively with patients can help overcome these barriers and improve adherence (82, 91). …”

Medication Adherence, Ethnicity, and the Influence of Multiple Psychosocial and Financial Barriers

“…For example, cognitive behavioral therapy and psychoeducation can improve illness insight and medication beliefs (Colom and Lam 2005). Cognitive adaptive therapy targets chaotic lifestyles or environmental instability detrimental to good adherence (Velligan et al 2008), while provider efforts to offer treatment closely aligned with patient-centered treatment or the chronic care model have proven successful (Sajatovic et al 2005). The quality of the therapeutic alliance can be addressed through ongoing clinician training (Weiden and Rao 2005), and providers who are more attentive to treatment guidelines can witness better adherence and outcomes among their patients (Dennehy et al 2005).…”

“I Really Don’t Know Whether it is Still There”: Ambivalent Acceptance of a Diagnosis of Bipolar Disorder

“…Sajatovic et al [17] have suggested that clinicians must take an active role in attempting to understand a patient's stance towards illness and adherence. This would involve an approach in which patients and clinicians were active collaborators in treatment decisions based on an understanding of the disorder that acknowledges both biological and psychosocial factors.…”