Improving treatment outcome in mental health by enhancing medication compliance
- Medication adherence, varying from 20 to 70% in mental health patients, is the degree to which a patient follows the prescribed timing and dosage of their medication regimen.1
- Psychiatric disorders introduce unique adherence challenges due to compromised decision-making abilities and the higher street value of controlled medications.7
- Technological components not aimed at monitoring accuracy but intended to boost motivation or ability, such as motivational interventions, psychoeducation, reminders, or social support, were categorized as “adherence-enhancing” interventions.7
- Prescribers should collaborate with patients to identify the underlying causes of nonadherence and then tailor specific support strategies to address these issues.9
- Patients with cohesive family structures and practical support tend to exhibit higher treatment adherence, highlighting the significant role of social support.3
Medication compliance in mental health
Medication adherence, defined as the extent to which a patient follows a prescribed dosing regimen, varies widely among mental health patients, with rates ranging from 20 to 70%. Factors such as substance misuse, negative attitudes towards treatment, doubts about therapy’s effectiveness, and strained healthcare relationships contribute to this inconsistency across disorders like schizophrenia, bipolar, and depression.1 In the U.S., nonadherence not only endangers individual health, leading to relapses and reduced quality of life, but also incurs substantial financial costs, around $100 billion annually.2 Notably, nearly half of major depression patients discontinue their antidepressants within three months, and adherence rates for disorders like schizophrenia and bipolar can be as low as 35%.2 The challenges posed by nonadherence, especially among substance misusers, underscore the urgent need for comprehensive research to improve outcomes.
Non-adherence to treatment can lead to symptom relapse, worsened mental health, repeated hospitalizations, extended disability, poorer quality of life, and a higher risk of suicide.3 Factors contributing to non-adherence include poor insight, negative attitudes towards medication, chronic illness, complex treatment plans, medication side effects, prescription costs, and poor social functioning. Additionally, socioeconomic issues, health system challenges, and other problem-related, treatment-related, and patient-related factors play a role in non-compliance.4 This article explores ways to enhance medication adherence in psychiatric care, improve treatment outcomes related to medication adherence, and highlight the importance of taking medications as prescribed for mental health.
Other interventions to tackle medication non-adherence can be found in our article titled “Interventions to tackle medication non-adherence”.
Strategies for promoting medication adherence in mental illness
Medication adherence is a crucial part of mental health care. It’s about patients taking their medications as prescribed. There are several strategies to help patients stick to their medication regimen.
A. Educational and behavioral strategies
Psychoeducation is another important strategy. This involves teaching patients and their families about the mental illness and why it’s important to stick to the medication plan. This can help patients understand their condition better, reduce stigma, and encourage a more positive attitude towards treatment.4
Behavioral strategies like motivational interviewing and cognitive-behavioral therapy can also help. These methods aim to change the beliefs and attitudes that might be causing a patient to not stick to their medication plan.4 For patients with severe mental illnesses or those living in remote areas, technological aids like electronic pill dispensers1 and telemedicine consultations can provide additional support.
B. Support services and organizational measures
Support services can help address specific problems with medication adherence. These services can include counseling to identify and change cognitive and motivational barriers to adherence. Cognitive adaptation training can provide environmental cues and supports to help with memory problems.4
Studies confirm that conscientious individuals often adhere better to medication, mirroring findings in chronic somatic or depressive disorders. These individuals excel at impulse control, goal-setting, and forward planning. Such traits likely facilitate their management of chronic psychiatric disorders’ treatment regimens.3
Details on the importance of medication compliance in mental health can be found in our article on importance of medication compliance in mental health.
Improving medication compliance in psychiatric care
Recognizing nonadherence is the pivotal first step in addressing medication compliance challenges in psychiatric care.5 Patients may deviate from treatment recommendations in various ways: adjusting their medication dosage, altering the timing of their doses, selectively following certain treatment protocols while neglecting others, or even discontinuing their medication entirely. It’s also crucial to note that adherence behaviors can change over time and can be either a deliberate choice or an inadvertent oversight. Once these patterns of nonadherence are identified, clinicians should tailor interventions based on the unique barriers each patient faces.6 By understanding these nuances and individual challenges, healthcare providers can craft more effective strategies to improve medication compliance.
A. Adopting a patient-centered approach
Psychoeducational programs are the most commonly implemented methods to boost adherence in those with mental health conditions. Additionally, the incorporation of mobile and information technologies, community pharmacist-led initiatives, and strategies to reduce medication costs are among the newer approaches being adopted to support patients in maintaining their treatment regimens.1
B. Building a therapeutic alliance
A therapeutic alliance, characterized by mutual trust and respect, can encourage patients to discuss their concerns openly. This relationship can help providers address these issues effectively. Involving patients in decision-making about their treatment can increase their sense of ownership and control, further improving adherence. It’s important to recognize that building this therapeutic alliance may take up to six months.4
C. Addressing medication compliance in treatment sessions
During treatment sessions, clinicians should address medication compliance specifically. Recognizing risk factors for non-compliance and addressing them during the session can help develop an effective treatment plan. This could include monitoring symptoms and side effects, providing access to information, and answering medication-related questions.4
D. Exploring innovative interventions
Recent research has explored various interventions to improve medication adherence. These include educating and counseling patients, monitoring medications, simplifying medication regimens, following up with phone calls, and emphasizing the importance of medication compliance through take-home videos. Other innovative interventions include mobile phone apps, interactive voice response, SMS, and websites. However, more research is needed to determine the effectiveness of these interventions. Furthermore, technological interventions, such as electronic pill dispensers and telemedicine consultations, can provide additional support for patients, particularly those with severe mental illnesses or those living in remote areas.7
Enhancing treatment outcomes in psychiatric medication adherence
Blending pharmacotherapy with psychotherapy often yields the best long-term results. Psychosocial strategies that prioritize adherence primarily vary from solely offering education about the disorder and its management to integrating education with behavioral and cognitive techniques to foster positive mindsets and adherence actions. Approaches where adherence is a secondary objective typically have a longer duration and incorporate a broader set of illness management techniques.8
Role of healthcare professionals in improving adherence
Healthcare professionals and medical institutions possess various strategies to detect and amplify medication adherence. While self-reporting is frequently the most convenient method for assessing adherence in clinical scenarios, it can sometimes overstate the actual levels. The choice of a method to boost adherence is influenced by the resources available within a specific medical establishment. Practical approaches to enhance adherence include using combination drugs to decrease the number of daily pills, engaging clinical pharmacists for collaborative disease management, and employing reminders, such as phone calls, for timely medication refills. To combat medication non-compliance, medical institutions might consider dedicating resources to more comprehensive, though potentially costlier, strategies like consistent counseling sessions with health educators or reducing/eliminating medication co-payments.5
Following are the key areas where pharmacists have been successful in improving medication adherence in patients with depression:4
Education and counseling: Educating patients on the importance of adherence, potential side effects, and regimen reviews.
Monitoring medications: Keeping track of medications and following up on drug reactions.
Prescription Adjustments: Prescribing medications and dose changes to simplify medication regimens under a given protocol.
Follow-up calls: Following up with a phone call and providing all information and response to a patient’s questions.
Emphasizing importance of adherence: Highlighting the importance of medication adherence through take-home videos.
Challenges in addressing compliance
Addressing medication compliance is a complex clinical challenge due to the multifaceted nature of the concept and the difficulty in measuring adherence. The risk factors associated with compliance issues are numerous, and the strategies proven to promote adherence are often embedded within broader psychosocial interventions.9
Towards a comprehensive approach in mental health care
Future research and clinical practice need to focus on understanding the main problems regarding nonadherence in individuals with mental health disorders. This understanding should include the patient’s perception of medication, illness, and behavior when taking medication. This knowledge will help determine the appropriate interventions based on the patient’s needs to improve adherence.
In conclusion, enhancing treatment outcomes in psychiatric medication adherence requires a multifaceted approach that includes patient education, personalized treatment plans, and a strong therapeutic alliance between the patient and healthcare providers. By addressing these factors, we can significantly improve medication compliance in mental health and, consequently, the overall treatment outcomes.9
Healthcare professionals, with their unique position in the healthcare system, play a pivotal role in this process. They interact with patients at every stage of their medication journey, from the initiation of a new treatment to any subsequent changes in the regimen. This ongoing interaction allows pharmacists to answer patients’ questions, discuss potential side effects, costs, and expectations of the medications, and provide additional interventions such as follow-up phone calls and education. These efforts can lead to an increase in medication compliance and, consequently, an improvement in the patient’s condition.4,9
However, it’s important to remember that improving medication compliance is just one piece of the puzzle in comprehensive mental health care. Addressing the broader social and environmental factors that impact mental health is equally crucial. By adopting a holistic, patient-centered approach, we can not only enhance the well-being of individuals with mental health disorders but also contribute to a healthier society.
Drugs don’t work in patients who don’t take them.- C. Everett Koop, M.D.
References
- García-Pérez, L., Linertová, R., Serrano-Pérez, P., Trujillo-Martín, M., Rodríguez-Rodríguez, L., Valcárcel-Nazco, C., & del Pino-Sedeño, T. Interventions to improve medication adherence in mental health: the update of a systematic review of cost-effectiveness. Int. J. Psychiatry Clin. Pract.2020; 24(4):416-427.
- Osterberg L, Blaschke T. Adherence to medication. N Engl J Med.2005; 353(5):487–497.
- Kirchner, Sophie-Kathrin, et al. Medication adherence in a cross-diagnostic sample of patients from the affective-to-psychotic spectrum: results from the PsyCourse study. Frontiers in Psychiatry. 2022: 713060
- Ehret, M. J., & Wang, M. How to increase medication adherence: What works?. Mental Health Clin. 2013; 2(8):230-232.
- Kini V, Ho PM. Interventions to Improve Medication Adherence: A Review. JAMA. 2018;320(23):2461–2473.
- Gibson S, Brand SL, Burt S, Boden ZVR, Benson O. Understanding treatment non-adherence in schizophrenia and bipolar disorder: a survey of what service users do and why. BMC Psychiatry. 2013; 13:153.
- Steinkamp, J. M., Goldblatt, N., Borodovsky, J. T., LaVertu, A., Kronish, I. M., Marsch, L. A., & Schuman-Olivier, Z. Technological interventions for medication adherence in adult mental health and substance use disorders: a systematic review. JMIR mental health. 2019; 6(3):e12493.
- Berk, L., Hallam, K. T., Colom, F., Vieta, E., Hasty, M., Macneil, C., & Berk, M. Enhancing medication adherence in patients with bipolar disorder. Hum. Psychopharmacol.2010;25(1):1-16.
- El-Mallakh, P., & Findlay, J. Strategies to improve medication adherence in patients with schizophrenia: the role of support services. Neuropsychiatr. Dis. Treat.2015: 1077-1090.