How to improve adherence to antipsychotic treatment: Outcomes of the IMproving PAtient outComes in psychiaTry (IMPACT) Berlin 2009 meeting workshop

Abstract

Objective. To challenge psychiatrists about their practice regarding patients' treatment adherence in severe mental disease, and make them discuss possible ways to improve this through their relationship with patients. Methods. A total of 423 physicians from 32 countries were assigned across 41 parallel groups during a workshop organised on adherence in severe mental diseases. Factors that influence adherence, and questions and measures to help patient-clinician interaction were discussed and rated. Results. The most important factor influencing adherence to treatment was considered to be insight. The factor over which clinicians felt they had the greatest influence was the therapeutic relationship. The question that most physicians considered the most useful for improving communication with patients was, "Does taking medication cause any problems for you?" Additional areas identified as important in improving adherence included addressing the positive and negative aspects of medication, patient expectations and what patients hoped to gain from seeing their physician. Intervention programmes to improve adherence included patient education, motivational interviewing and cognitive-behavioural therapy. A composite toolkit based on the top-rated questions to improve communication with patients and measures to aid adherence was recommended. Conclusion. Patient-centred practice is fundamental to ensuring adherence in mentally ill patients. Working tools can be successfully developed in interactive workshop settings, through reviewing and challenging current clinical practice.

What are patients’ experiences of discontinuing clozapine and how does this impact their views on subsequent treatment?

“…The themes of positive and negative effects, agency, and feelings about future treatment are all linked to true shared decision making, defined by NICE 2021 [ 54 ] as “a collaborative process that involves a person and their healthcare professional working together to reach a joint decision about care” and incorporating “the person’s individual preferences, beliefs and values” [ 78 ]. Feelings about treatment are influenced by a trusting relationship with clinicians [ 9 , 22 , 55 , 57 , 58 ] which can be built through shared decision making. Participants reflecting on previous clozapine treatment and balancing this with the risks and benefits of current treatment, demonstrate the potential for sophisticated decision making.…”

“…Identifying why people discontinue clozapine and the impact this experience has on subsequent treatments may assist in personalising treatment [ 6 – 8 , 11 , 13 , 16 ]. Shared decision making through clinician and patient working in partnership [ 43 , 54 ], building trust, sharing knowledge, and understanding beliefs or concerns, is believed to lead to better medicine adherence [ 1 , 9 , 22 , 43 , 44 , 50 , 55 – 58 ]. Effectively treating schizophrenia promptly facilitates better management of social and physical health issues for optimal overall health outcomes [ 10 , 59 ].…”