Effect of a Multi-Dimensional and Inter-Sectoral Intervention on the Adherence of Psychiatric Patients
October
Effect of a Multi-Dimensional and Inter- Sectoral Intervention on the Adherence of Psychiatric Patients
Anne Pauly 0 1
Carolin Wolf 0 1
Andreas Mayr 0 1
Bernd Lenz 0 1
Johannes Kornhuber 0 1
Kristina Friedland 0 1
0 1 Molecular & Clinical Pharmacy, Friedrich-Alexander University Erlangen-Nürnberg (FAU) , Erlangen, Germany , 2 Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen- Nürnberg (FAU) , Erlangen, Germany , 3 Department of Medical Informatics , Biometry and Epidemiology , Friedrich-Alexander-University Erlangen-Nürnberg (FAU) , Erlangen , Germany
1 Editor: Christopher G Davey, University of Melbourne , AUSTRALIA
In psychiatry, hospital stays and transitions to the ambulatory sector are susceptible to major changes in drug therapy that lead to complex medication regimens and common nonadherence among psychiatric patients. A multi-dimensional and inter-sectoral intervention is hypothesized to improve the adherence of psychiatric patients to their pharmacotherapy.
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Competing Interests: The authors have declared
that no competing interests exist.
269 patients from a German university hospital were included in a prospective, open, clinical
trial with consecutive control and intervention groups. Control patients (09/2012-03/2013)
received usual care, whereas intervention patients (05/2013-12/2013) underwent a
program to enhance adherence during their stay and up to three months after discharge. The
program consisted of therapy simplification and individualized patient education
(multidimensional component) during the stay and at discharge, as well as subsequent phone
calls after discharge (inter-sectoral component). Adherence was measured by the
“Medication Adherence Report Scale” (MARS) and the “Drug Attitude Inventory” (DAI).
The improvement in the MARS score between admission and three months after discharge
was 1.33 points (95% CI: 0.73–1.93) higher in the intervention group compared to controls.
In addition, the DAI score improved 1.93 points (95% CI: 1.15–2.72) more for intervention
patients.
These two findings indicate significantly higher medication adherence following the
investigated multi-dimensional and inter-sectoral program.
German Clinical Trials Register DRKS00006358
Non-adherence to medication is one of the main causes for unsuccessful pharmacotherapy in
psychiatry [1]. For example, the risk of hospitalization for non-adherent patients with
schizophrenia is reported to be four times higher than for adherent patients [2]. It is assumed that
increasing adherence might be the most efficacious way to further improve health care
outcome [3].
Adherence is influenced by social and economic factors, the health care team/system, the
characteristics of the disease, disease therapies and patient-related factors, as defined by the
WHO [3]. Successful interventions should ideally target several of these dimensions because
single-faceted interventions have frequently failed to show an impact [4]. Besides affecting
practical barriers to adherence (e.g. dosing frequency), perceptual barriers, including the
patient’s individual risk-benefit-assessment, should also be addressed [5]. Thus far, this
dimension has only been considered in a few studies [5].
Successful research aimed at improving adherence in psychiatric patients and at developing
a program for daily clinical practice in the hospital is rare. Previous investigations mainly
enhanced the patient’s knowledge and insight [6,7] and focused on outpatients [8,9], but did
not combine the beneficial therapy simplifications [10] with individualized patient education.
The hospital stay and the time after discharge are periods that are susceptible to major changes
in drug therapy that lead to patient uncertainty [11]. Hence, the transition between inpatient
care and the ambulatory sector should be a point of focus by health care professionals.
Therefore, we investigated the effect of a multi-dimensional and inter-sectoral program on
the patients’ adherence using a controlled study design in a psychiatric inpatient setting. The
program started during the stay and ended three months after discharge. The additional
program was administered only to patients in the intervention group. It included the provision of
individualized verbal and written information regarding the patient’s specific psychiatric
medication and diseases with subsequent telephone calls after discharge that focused on the patients’
concerns about their pharmacotherapy as well as maintaining adherence. Additionally, a
medication review targeting the simplification of the pharmacotherapeutic regimen was performed.
Control patients received usual care that included the dispensing of medication by ward staff
and group counseling about medication once during their stay. The patient’s individual
adherence was measured by the self-report questionnaires “Medication Adherence Report Scale”
(MARS) [12] and “Drug Attitude Inventory” (DAI) [13] at admi (...truncated)