1
|
Klinpiboon P, Chanthapasa K. The Medication Use Issues and Challenges of Mental Illness Exacerbation in Patients with Schizophrenia: A Qualitative Study in Thailand. Patient Prefer Adherence 2023; 17:2927-2937. [PMID: 38027087 PMCID: PMC10656350 DOI: 10.2147/ppa.s420973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Patients with schizophrenia often experience mental illness exacerbations, which lead to frequent re-hospitalization. Non-adherence to medication is the main cause of relapses, despite many patients requiring lifelong treatment. Non-adherence consequences include higher re-admission and suicide rates, worse progression of mental illness, higher rates of violence by patients with mental illness, and increased use of emergency psychiatric services. This directly impacts the cost and workload of the mental healthcare system. This study aims to understand medication non-adherence among schizophrenia patients in Thailand based on the country's specific context. Patients and Methods This qualitative research study explored the causes of non-adherence to medication and health perceptions among patients with schizophrenia in Thailand. Five patients with schizophrenia were included in this study. Data was collected through in-depth interviews, recordings of treatments, and field notes based on the interpretive perspective of key informants with the concept of phenomenology. Results Thematic analysis revealed two main themes associated with mental illness exacerbation: triggers of exacerbation and medication non-adherence. The triggers that emerged from the data were substance abuse and psychological stress. Medication non-adherence issues were misunderstandings about mental illness and its treatment, lack of participation in treatment, and difficulty accessing mental health services. Conclusion This study explored the importance of medication adherence in patients with schizophrenia. Non-adherence to medication can worsen mental illness and create a vicious cycle that makes treatment more challenging. Substance abuse and psychological stress can also exacerbate this cycle. Mental health services should strive to improve medication adherence strategies and offer social support to prevent harmful behaviors and break the vicious cycle.
Collapse
Affiliation(s)
- Ponglapat Klinpiboon
- Department of Pharmacy, Nakhon Ratchasima Rajanagarindra Psychiatric Hospital, Nakhon Ratchasima, Thailand
- Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | | |
Collapse
|
2
|
Barliana MI, Ramdini DA, Afifah NN, Alfian SD, Sumiwi SA. Investigating the Effect of Adherence to Antipsychotic Therapy on the Length of Stay and Number of Hospitalizations in Patients with Schizophrenia - A Descriptive Analysis. Patient Prefer Adherence 2023; 17:2737-2747. [PMID: 37936717 PMCID: PMC10625877 DOI: 10.2147/ppa.s430083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/20/2023] [Indexed: 11/09/2023] Open
Abstract
Background Optimizing long-term outcomes in schizophrenia treatment requires effective pharmacological interventions. Medication adherence is known to influence clinical outcomes, yet there is a scarcity of studies examining its correlation with factors like Length of Stay (LOS) and re-hospitalization frequency. These outcomes are crucial indicators of how medication adherence affects overall patient well-being. Purpose This study aims to describe the effect of medication adherence on the length of stay (LOS) and number of hospitalizations in patients with schizophrenia. Patients and Methods A total of 157 subjects from the West Java Psychiatric Hospital were included in this cross-sectional retrospective study. Data, including demographics, comorbidities, duration of illness, antipsychotic adherence, LOS, and the number of hospitalizations, were collected from the patients' medical records. All the data were analyzed using the Chi-Square (χ²) test with a significance level set at p < 0.05. Results Our findings showed that 88% of all schizophrenia inpatients were in the nonadherence group. The highest (40.7%) LOS (>30 days) was found in the non-adherence group with discontinued therapy/stopped therapy group, while the highest percentage of patients with less than five hospitalizations was identified in the obedient and regular therapy group (94.4%). In the statistical results, we observed a significant association between therapy adherence (p = 0.043) and therapy regimen (p = 0.014) with gender. Additionally, the distinction between male and female schizophrenia patients demonstrated statistical significance (p = 0.000). Conclusion In this study, therapy adherence and therapy regimen were found to have a significant association with gender, as well as differences between the number of male and female schizophrenia patients that were statistically significant. While other variables may exhibit clinical associations, their statistical significance has not been fully depicted. The results of this study could be preliminary study for subsequent observational studies.
Collapse
Affiliation(s)
- Melisa Intan Barliana
- Department of Biological Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Dwi Aulia Ramdini
- Department of Pharmacy, Faculty of Medicine, Universitas Lampung, Bandar Lampung, Indonesia
| | - Nadiya Nurul Afifah
- Department of Biological Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Sofa Dewi Alfian
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
- Department of Pharmacology and Clinical Pharmacy Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Sri Adi Sumiwi
- Department of Pharmacology and Clinical Pharmacy Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| |
Collapse
|
3
|
Effectiveness of Interventions to Promote Medication Adherence in Schizophrenic Populations in Thailand: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052887. [PMID: 35270585 PMCID: PMC8910437 DOI: 10.3390/ijerph19052887] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 01/19/2023]
Abstract
Medication non-adherence is a leading cause of poor treatment outcomes among Thai patients with psychiatric disorders and creates challenges for psychiatric nurses. This systematic review synthesized research on intervention effectiveness for antipsychotic medication adherence in Thai schizophrenic populations. Following PRISMA guidelines, searches were completed in seven databases, including PubMed, PsycINFO, CINAHL, Web of Science, Scopus, ThaiJO, and Google Scholar. No restriction dates were used. Screening and extraction of data were performed systematically. Eligible studies consisted of nine quasi-experimental and two randomized control trial studies. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used to assess the studies’ methodological quality. This review revealed that individual counseling combined with cognitive-behavioral therapy (CBT) and motivational interviewing (MI) techniques improved and maintained medication adherence behavior over time. Post-testing after intervention completion and at 3- and 6-month follow-ups showed that treatment group participants were more adherent than control group participants (p < 0.01). These findings suggest that incorporating CBT and MI into clinical practice can enhance medication adherence behavior. Booster session efficacy for reinforcing and sustaining adherence should be investigated. Greater rigor is warranted in future intervention studies based on a quality appraisal of previous studies.
Collapse
|
4
|
Hsieh WL, Yeh ST, Liu WI, Li IH, Lee SK, Chien WT. Improving Medication Adherence in Community-Dwelling Patients with Schizophrenia Through Therapeutic Alliance and Medication Attitude: A Serial Multiple Mediation Model. Patient Prefer Adherence 2022; 16:1017-1026. [PMID: 35444409 PMCID: PMC9014223 DOI: 10.2147/ppa.s351848] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/19/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Increased medication adherence improves patient outcomes and lowers the overall cost of care by preventing disease relapse and hospital readmission. Several systematic reviews have identified that insight, therapeutic alliance, and attitude towards medication affect medication adherence in patients with schizophrenia; however, no study has examined all the aforementioned variables together nor has discussed the chains of these mediators. PURPOSE To examine the insight-medication adherence relationship among community-dwelling schizophrenia patients through a serial multiple mediation model of therapeutic alliance and medication attitude. PATIENTS AND METHODS This study with a cross-sectional correlational design included a convenience sample of community-dwelling schizophrenia patients from Taiwan (n = 229). From January 2017 to January 2018, data were collected by trained nurses using questionnaires. The PROCESS tool was used to analyse fine-grained chains. RESULTS In serial multiple mediation, the indirect effect of insight on medication adherence through therapeutic alliance and, subsequently, alteration of medication attitude was significant. However, the direct effect changed from significant to non-significant, indicating a complete mediating effect. CONCLUSION In community-dwelling schizophrenia patients, the effects of therapeutic alliance and medication attitude on medication adherence are greater than that of insight. We recommend revising the strategy of community home visits by different psychiatrists or nurses in alternating shifts. Therapeutic alliance is the first step required to promote medication adherence. Based on this alliance, altering the patients' medication attitude may be more effective in improving medication adherence than merely enhancing insight.
Collapse
Affiliation(s)
- Wen Ling Hsieh
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Shin Ting Yeh
- Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Wen I Liu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
- Correspondence: Wen I Liu, School of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Ming-Te Road, Peitou District, Taipei City, 112303, Taiwan, Tel +886-2-28227101 ext. 3184, Fax +886-2-28213233, Email
| | - I Hsien Li
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Shih Kai Lee
- Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou, Taiwan
- Shih Kai Lee, Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, No. 161, Yu-Pin Road, Tsaotun Township, Nan-Tou, 54249, Taiwan, Tel +886-49-2550800 ext. 2100, Email
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| |
Collapse
|
5
|
Velligan DI, Sajatovic M, Sierra C, Mintz J, Merker JM, Cassidy KA, Runnels P. A Program to Increase the Appropriate Use of Long-Acting Injectable Antipsychotic Medications in Community Settings. Psychiatr Serv 2021; 72:1012-1017. [PMID: 34018816 DOI: 10.1176/appi.ps.201900545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Multilevel Facilitation of Long-Acting Antipsychotic Medication Program (MAP) is a novel intervention to increase the appropriate use of long-acting injectable (LAI) antipsychotics in community mental health clinics. The authors investigated the feasibility of MAP, facilitators and barriers to use, and preliminary impact on LAI medication use. METHODS Two clinics in Texas and two in Ohio serving 750 and 617 individuals with schizophrenia receiving oral antipsychotics, respectively, were asked to change clinical procedures for 1 year by using either the not receiving optimum benefit (NOB) checklist or the checklist plus MAP. Providers used the NOB checklist to identify individuals who could benefit from switching to LAI antipsychotics. MAP clinics used the NOB checklist plus nonbranded academic detailing for providers and a shared-decision-making video and tool for consumers. Use of MAP components was tracked, and barriers and facilitators were collected quarterly. Antipsychotic prescription counts were provided by participating clinics. RESULTS Barriers to use of MAP included loss of local champions and administrators, difficulty with provider buy-in, limited availability of peer specialists, and a lack of infrastructural support to integrate MAP into clinic flow. Higher scores on the NOB checklist were associated with more provider LAI medication offers and greater patient acceptance of LAI antipsychotics. LAI medication use increased in clinics over time, but it is unclear whether this increase was due to MAP. CONCLUSIONS Changing MAP components to fit local procedures and to circumvent unique barriers could aid implementation. Further research should investigate the potential impact of MAP components on LAI medication use.
Collapse
Affiliation(s)
- Dawn I Velligan
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio (Velligan, Sierra, Mintz); Department of Neurology (Sajatovic) and Department of Psychiatry (Sajatovic, Cassidy, Runnels), Case Western Reserve University School of Medicine, Cleveland; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Cassidy, Runnels); The Centers for Families and Children, Circle Health Services, Cleveland (Merker)
| | - Martha Sajatovic
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio (Velligan, Sierra, Mintz); Department of Neurology (Sajatovic) and Department of Psychiatry (Sajatovic, Cassidy, Runnels), Case Western Reserve University School of Medicine, Cleveland; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Cassidy, Runnels); The Centers for Families and Children, Circle Health Services, Cleveland (Merker)
| | - Cynthia Sierra
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio (Velligan, Sierra, Mintz); Department of Neurology (Sajatovic) and Department of Psychiatry (Sajatovic, Cassidy, Runnels), Case Western Reserve University School of Medicine, Cleveland; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Cassidy, Runnels); The Centers for Families and Children, Circle Health Services, Cleveland (Merker)
| | - Jim Mintz
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio (Velligan, Sierra, Mintz); Department of Neurology (Sajatovic) and Department of Psychiatry (Sajatovic, Cassidy, Runnels), Case Western Reserve University School of Medicine, Cleveland; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Cassidy, Runnels); The Centers for Families and Children, Circle Health Services, Cleveland (Merker)
| | - Julie M Merker
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio (Velligan, Sierra, Mintz); Department of Neurology (Sajatovic) and Department of Psychiatry (Sajatovic, Cassidy, Runnels), Case Western Reserve University School of Medicine, Cleveland; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Cassidy, Runnels); The Centers for Families and Children, Circle Health Services, Cleveland (Merker)
| | - Kristin A Cassidy
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio (Velligan, Sierra, Mintz); Department of Neurology (Sajatovic) and Department of Psychiatry (Sajatovic, Cassidy, Runnels), Case Western Reserve University School of Medicine, Cleveland; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Cassidy, Runnels); The Centers for Families and Children, Circle Health Services, Cleveland (Merker)
| | - Patrick Runnels
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio (Velligan, Sierra, Mintz); Department of Neurology (Sajatovic) and Department of Psychiatry (Sajatovic, Cassidy, Runnels), Case Western Reserve University School of Medicine, Cleveland; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland (Sajatovic, Cassidy, Runnels); The Centers for Families and Children, Circle Health Services, Cleveland (Merker)
| |
Collapse
|
6
|
Pennington M, McCrone P. Does Non-Adherence Increase Treatment Costs in Schizophrenia? PHARMACOECONOMICS 2018; 36:941-955. [PMID: 29700755 DOI: 10.1007/s40273-018-0652-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Medication non-adherence is a serious barrier to treatment of schizophrenia. Understanding the impact of non-adherence on costs is essential to the assessment of the cost effectiveness of interventions in which adherence to treatment is a concern. OBJECTIVES We undertook a comprehensive review of the available literature on the impact on costs of non-adherence to antipsychotics in the treatment of schizophrenia. METHODS We performed a search on multiple databases (MEDLINE, Embase, PsycINFO and Health Management Information Consortium) for any study reporting the impact of adherence to antipsychotics on costs in patients with schizophrenia up to February 2018. We included trials of behavioural interventions but excluded comparisons of different pharmacological therapies. Studies were included if at least one-third of the study population had schizophrenia and costs were reported. RESULTS Thirty-four publications on 28 studies met the inclusion criteria. Twenty studies reported analyses of administrative databases, primarily Medicaid. Findings on healthcare costs were mixed but suggested that lower pharmacy costs in non-adherent patients may outweigh increased hospitalisation costs where drug costs are relatively high. A few studies published analysis of prospective cohort data, or trials of behavioural interventions intended to influence adherence, mainly in a European setting. Findings were again mixed but indicate that increasing adherence does not reduce overall costs. CONCLUSIONS Inference from analysis of administrative data is limited by the risk of selection bias. Inference from trials is limited by small sample sizes. The literature does not consistently support an assumption that non-adherence increases healthcare costs.
Collapse
Affiliation(s)
- Mark Pennington
- King's Health Economics, PO24 David Goldberg Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Paul McCrone
- King's Health Economics, PO24 David Goldberg Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| |
Collapse
|