Does adherence therapy improve medication adherence among patients with schizophrenia? A systematic review

Abstract

Non-adherence to medication is highly prevalent in patients with schizophrenia. Adherence therapy aims to improve medication adherence of these patients by applying techniques of cognitive behavioural therapy, psycho-education, and motivational interviewing. Even though adherence therapy is frequently discussed and researched, its effectiveness is still uncertain. This paper aims to review the effectiveness of adherence therapy on the medication adherence of patients with schizophrenia. To this end, six electronic databases were systematically searched for randomized, controlled trials on adherence therapy from January 2002 to March 2013. Four trials met the inclusion criteria and were incorporated into the review. The findings suggest that adherence therapy does not improve patients' medication adherence in comparison to treatment as usual or a control intervention. However, all the studies reviewed showed high-adherence ratings at baseline. Thus, further well-designed studies that target adherence therapy to patients who are non-adherent to their medication are needed for a more profound understanding of its effectiveness. In addition, if adherence therapy is aimed not only at improving medication adherence, but also to reach an agreement whereby the patient's decision not to take his medication is accepted, the shared decision-making process needs to be assessed as well.

Effect of a Telephone Intervention upon Medication Adherence and Related Outcomes in Outpatients with Schizophrenia Spectrum Disorders (SSDs)

“…These adherence percentages are lower than the average nonadherence rate of 60% reported by others [2,4]. Compared to our prior work [15], average pill count psychiatric medication adherence in this study was lower for both experimentals and controls; average nonpsychiatric medication adherence in this study was higher for both groups.…”

“…Great number (upto 74%) of persons with schizophrenia spectrum disorders (schizophrenia, schizophreniform disorder and schizoaffective disorder-SSDs) are defined as nonadherent (take less than 80% of doses prescribed) to their antipsychotic medications [1], and poor adherence is leading contributor to SSD relapse [2]. Relapses increase disability, shorten remissions and reduce responsiveness to subsequent treatments, all of which increase the likelihood of costly rehospitalizations.…”

“…Poor psychiatric medication adherence results in increased illness episodes associated with re-hospitalizations, longer time to remission and suicide attempts [2], all of which contribute to the exceedingly high personal and societal cost of SSDs. While the efficacy of antipsychotic medication for SSD maintenance is well documented [3], rates of nonadherence to antipsychotic medications in persons with SSDs range from 11-80% with average nonadherence exceeding 60% [4].…”

The rationale for shared decision making in mental health care: a systematic review of academic discourse

“…For example, because the term 'adherence' implies a rule is being followed (Mahone, Maphis, & Snow, 2016), reinforces the power of the clinician, or does not recognise a decision to stop taking medicine as a rational choice, informed by lived experience (Deegan, 2007). Others noted that 'adherence' is not the primary goal of most shared decision making interventions (Stein et al, 2013) and that non-adherence can indicate a breakdown of the decision making process so may be a positive outcome in cases where the care plan does not meet the goals of the individual (Hegedus & Kozel, Dec 2014;Seale et al, 2006) …”

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“…Cilj je ove terapije promjena stavova prema uzimanju lijekova, što je za pretpostavku imalo poboljšanje kliničkog stanja i prevenciju recidiva bolesti 58,59 . Terapija suradljivosti označena je kao kratki terapijski postupak koji se koristi tehnikom motivacijskog intervjuiranja 60,61 , psihoedukacijom i kognitivnom terapijom 58,62 . Obično se sastoji od tri do četiri seanse u trajanju od 30 do 60 minuta, a primjenjuje se kao pristup kroz nekoliko faza, što se odnosi na: 1. uvid u povijest bolesti i medikamentoznu terapiju, 2. istraživanje ambivalencije prema liječenju, terapiji održavanja i stigmi te 3. provođenje tehnike rješavanja problema u odnosu na uzimanje lijekova kako bi se uspostavio pozitivan stav prema uzimanju lijekova.…”