Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis

Abstract

Background: Major psychiatric disorders are growing public health concern that attributed 14% of the global burden of diseases. The management of major psychiatric disorders is challenging mainly due to medication nonadherence. However, there is a paucity of summarized evidence on the prevalence of psychotropic medication non-adherence and associated factors. Therefore, we aimed to summarize existing primary studies' finding to determine the pooled prevalence and factors associated with psychotropic medication non-adherence. Methods: A total of 4504 studies written in English until December 31, 2017, were searched from the main databases (n = 3125) (PubMed (MEDLINE), Embase, CINAHL, PsycINFO, and Web of Science) and other relevant sources (mainly from Google Scholar, n = 1379). Study selection, screening, and data extraction were carried out independently by two authors. Observational studies that had been conducted among adult patients (18 years and older) with major psychiatric disorders were eligible for the selection process. Critical appraisal of the included studies was carried out using the Newcastle Ottawa Scale. Systematic synthesis of the studies was carried out to summarize factors associated with psychotropic medication non-adherence. Meta-analysis was carried using Stata 14. Random effects model was used to compute the pooled prevalence, and subgroup analysis at 95% confidence interval. Results: Forty-six studies were included in the systematic review. Of these, 35 studies (schizophrenia (n = 9), depressive (n = 16), and bipolar (n = 10) disorders) were included in the meta-analysis. Overall, 49% of major psychiatric disorder patients were non-adherent to their psychotropic medication. Of these, psychotropic medication non-adherence for schizophrenia, major depressive disorders, and bipolar disorders were 56%, 50%, and 44%, respectively. Individual patient's behaviors, lack of social support, clinical or treatment and illness-related, and health system factors influenced psychotropic medication non-adherence. Conclusion: Psychotropic medication non-adherence was high. It was influenced by various factors operating at different levels. Therefore, comprehensive intervention strategies should be designed to address factors associated with psychotropic medication non-adherence.

Clinicians' Values and Preferences for Medication Adherence and Cost Clinical Decision Support in Primary Care: A Qualitative Study

“…While medication nonadherence is a universal issue, the burden of medication cost on the patient may vary in other countries due to different health care system models being utilized (e.g., universal health care system vs. subsidized vs. mixed). [54][55][56][57] Additionally, drug prices in the United States are high due to lack of regulation or negotiation about prices of new prescription medications introduced into the market, whereas other countries employ methods to control drug pricing. 58 Despite these variations, even patients being cared for within a different health care system model may experience medication cost barriers and, as a result, experience poor outcomes; thus, research on what tools clinicians practicing in those areas would desire to help minimize cost barriers at point of prescribing would be beneficial.…”

Psychopharmacological Medication Has No Influence on Vitamin Status After Bariatric Surgery in Long-term Follow-up

“…There might also be some patients with underlying psychiatric disorders in the control group, which were not detected due to missing therapy or due to non-adherence to psychopharmacological therapy. Non-adherence to psychotropic medication is reported to be high among patients with psychiatric disorders [19].…”

“…[ 16 – 18 ]. In patients with psychiatric disorders, non-adherence to recommended psychopharmacological medication can be expected in up to 50% of long-term prescriptions and thus remains a significant challenge [ 19 ]. Adherence to recommended supplementation after bariatric surgery might be reduced due to symptoms of psychiatric disorders (e.g., reduced motivation, reduced self-care, cognitive impairment, eating disorders, or substance use disorders).…”

Individual Health Budgets in Mental Health: Results of Its Implementation in the Friuli Venezia Giulia Region, Italy

“…Fifthly, we did not include pharmacological assessment, which could have affected HoNOS ratings. In mental health services there are patients with little or no compliance to pharmacological therapy [ 58 ]. Since we could not assess the distribution of patients following a regular treatment in the two groups, this could have confounded our results, leading to higher HoNOS ratings, due to scarce compliance, in a group compared to another.…”