Medication Adherence and Hospitalization Among Patients With Schizophrenia Treated With Antipsychotics

Lang, Kathleen; Meyers, Juliana; Korn, Jonathan R.; Lee, Seina; Sikirica, Mirko; Crivera, Concetta; Dirani, Riad; Menzin, Joseph

doi:10.1176/ps.2010.61.12.1239

Cited by 85 publications

(52 citation statements)

References 24 publications

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“…It should be noted, however, that in this study, patients with awareness of their illness were also more likely to have other characteristics that may contribute to nonadherence, including substance abuse and sensitivity to the stigma associated with taking antipsychotic medication 29. In the aforementioned study that surveyed 699 psychiatrists,2 stigma was the barrier to adherence most frequently described by patients, and research has shown that substance abusers are at a significantly higher risk for medication nonadherence compared with nonusers 9. A team approach to support adherence and overcome barriers to nonadherence is therefore essential in all patients, although the type and intensity of the intervention may vary based on the characteristics of the individual patient.…”

Section: Resultsmentioning

confidence: 67%

“…In a patient survey study that was conducted by nurses, the two most prominent barriers to medication adherence were stigma associated with taking medication and adverse drug reactions 2. Evidence also suggests that a variety of other factors may play a role in pharmacotherapy nonadherence among patients with schizophrenia, including the drug class prescribed (ie, typical versus atypical antipsychotics),3–5 drug formulation (ie, oral versus long-acting injectable [LAI] formulation),6 lack of adequate social support,7 lack of access to health care,8 and concurrent substance abuse 9. In patients with schizophrenia, nonadherence to prescribed medication is associated with symptom relapse, increased hospitalizations, and increased health care costs 10,11…”

Section: Introductionmentioning

confidence: 99%

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Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

Shuler¹

2014

PPA

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PurposeIn patients with schizophrenia, nonadherence to prescribed medications increases the risk of patient relapse and hospitalization, key contributors to the costs associated with treatment. The objectives of this review were to evaluate the impact of nonadherence to pharmacotherapy in patients with schizophrenia as it relates to health care professionals, particularly social workers, and to identify effective team approaches to supporting patients based on studies assessing implementation of assertive community treatment teams.Materials and methodsA systematic review of the medical literature was conducted by searching the Scopus database to identify articles associated with treatment adherence in patients with schizophrenia. Articles included were published from January 1, 2003, through July 15, 2013, were written in English, and reported findings concerning any and all aspects of nonadherence to prescribed treatment in patients with schizophrenia.ResultsOf 92 unique articles identified and formally screened, 47 met the inclusion criteria for the systematic review. The burden of nonadherence in schizophrenia is significant. Factors with the potential to affect adherence include antipsychotic drug class and formulation, patient-specific factors, and family/social support system. There is inconclusive evidence suggesting superior adherence with an atypical versus typical antipsychotic or with a long-acting injectable versus an oral formulation. Patient-specific factors that contribute to adherence include awareness/denial of illness, cognitive issues, stigma associated with taking medication, substance abuse, access to health care, employment/poverty, and insurance status. Lack of social or family support may adversely affect adherence, necessitating the assistance of health care professionals, such as social workers. Evidence supports the concept that an enhanced team-oriented approach to managing patients with schizophrenia improves adherence and supports corresponding reductions in relapse rates, inpatient admissions, and associated costs.ConclusionOptimization of medication and involvement of caregivers are important to promoting adherence. A multidisciplinary team approach may be invaluable in identifying barriers to adherence and helping schizophrenia patients overcome them.

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Section: Resultsmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

Shuler¹

2014

PPA

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“…[46] The influence of family on compliance is a modifiable factor which can be achieved through psychoeducation. [114849] Implementation of this measure is beset with operational difficulties in countries with limited workforce. Stigma of mental illness affecting compliance and noncompliance has been reported in previous studies.…”

Section: Discussionmentioning

confidence: 99%

Treatment compliance and noncompliance in psychoses

Rao

George

Sudarshan

et al. 2017

Indian J Psychiatry

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Background:Compliance or noncompliance with treatment significantly influences course and outcome of psychiatric disorders. While noncompliance has been extensively researched, compliance has received less attention. The current study was conducted to elicit reasons for compliance and noncompliance in patients having psychoses attending psychiatric clinics.Materials and Methods:A total of 196 compliant and 150 noncompliant patients were interviewed using self-designed tools to elicit sociodemographic data, details of illness, and treatment. Factors contributing to compliance and noncompliance were grouped under illness-related, clinician-related, medication-related, family-related, and economic-related domains and compared.Results:Compliance was significantly more in females and middle- and high-socioeconomic status patients. They had less substance use, high physical comorbidity, high attendance in the outpatient department, and better remission. Clinician-related, family-related, and medication-related domains were contributing more to compliance whereas illness-related and economic-related domains seemed to have more bearing on noncompliance.Conclusions:Compliance and noncompliance are determined multidimensionally. Domains related to clinician, family, and medications have to be reinforced to enhance compliance. Illness-related and economic domains have to be resolved to reduce noncompliance.

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“…Poor treatment adherence is one of the strongest predictors of relapse and hospitalization 15–18. It has been linked to lack of insight into illness,3,19 use of first-generation antipsychotics instead of second-generation antipsychotics,20 poor therapeutic alliance,19,21 comorbid substance use,19,21,22 poor treatment efficacy,23 and treatment tolerability issues 23. Understanding and improving early treatment adherence may improve longer-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with early response to olanzapine and clinical and functional outcomes of early responders treated for schizophrenia in the People’s Republic of China

Ye¹,

Montgomery²,

Kadziola³

et al. 2014

NDT

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BackgroundThe aims of this analysis were to identify factors associated with early response (at 4 weeks) to olanzapine treatment and to assess whether early response is associated with better longer-term outcomes for patients with schizophrenia in the People’s Republic of China.MethodsA post hoc analysis of a multi-country, 6-month, prospective, observational study of outpatients with schizophrenia or bipolar mania who initiated or switched to treatment with oral olanzapine was conducted using data from the Chinese schizophrenia subgroup (n=330). Factors associated with early response were identified using a stepwise logistic regression with baseline clinical characteristics, baseline participation in a weight control program, and adherence with antipsychotics during the first 4 weeks of treatment. Mixed models for repeated measures with baseline covariates were used to compare outcomes over time between early responders and early nonresponders to olanzapine.ResultsOne hundred and thirty patients (40%) achieved an early response. Early response was independently predicted by higher baseline Clinical Global Impressions-Severity score (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.15–1.97), fewer years since first diagnosis (OR 0.94, CI 0.90–0.98), a greater number of social activities (OR 1.22, CI 1.05–1.40), participation in a weight control program (OR 1.81, CI 1.04–3.15), and high adherence with antipsychotics during the first 4 weeks of treatment (OR 2.98, CI 1.59–5.58). Relative to early nonresponders, early responders were significantly more likely to meet treatment response criteria at endpoint, had significantly greater symptom improvement (Clinical Global Impressions-Severity), and had significantly greater improvement in functional outcomes (all P<0.05).ConclusionHigh levels of adherence to prescribed antipsychotics and participation in a weight control program were associated with early response to olanzapine in Chinese patients with schizophrenia. Early response was associated with greater improvement in symptomatic, functional, and quality of life outcomes at 6 months compared with early nonresponse. Current findings are consistent with previous research outside of the People’s Republic of China.

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Medication Adherence and Hospitalization Among Patients With Schizophrenia Treated With Antipsychotics

Abstract: Results document rates of antipsychotic adherence and predictors of nonadherence and hospitalization. Findings may be useful to health plan administrators, formulary decision makers, and physicians.

Cited by 85 publications

References 24 publications

Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

Treatment compliance and noncompliance in psychoses

Factors associated with early response to olanzapine and clinical and functional outcomes of early responders treated for schizophrenia in the People’s Republic of China

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Medication Adherence and Hospitalization Among Patients With Schizophrenia Treated With Antipsychotics

Abstract: Results document rates of antipsychotic adherence and predictors of nonadherence and hospitalization. Findings may be useful to health plan administrators, formulary decision makers, and physicians.

Cited by 85 publications

References 24 publications

Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

Treatment compliance and noncompliance in psychoses

Factors associated with early response to olanzapine and clinical and functional outcomes of early responders treated for schizophrenia in the People&rsquo;s Republic of China

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Product

Resources

About

Factors associated with early response to olanzapine and clinical and functional outcomes of early responders treated for schizophrenia in the People’s Republic of China