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Articles   |    
Psychiatrist and Patient Responses to Suspected Medication Nonadherence in Schizophrenia Spectrum Disorders
Johannes Hamann, M.D.; Marie-Luise Lipp; Sarah Christ-Zapp, M.D.; Ilja Spellmann, M.D.; Werner Kissling, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300322
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Dr. Hamann, Ms. Lipp, Dr. Christ-Zapp, and Dr. Kissling are with the Psychiatry Department, Technische Universität München, Munich, Germany (e-mail: j.hamann@lrz.tum.de). Dr. Spellmann is with Bezirkskliniken Schwaben Kaufbeuren, Kaufbeuren, Germany.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Long-term results in schizophrenia treatment continue to be unsatisfactory, with many patients nonadherent to treatment and relapsing frequently. This study aimed to examine how perceived nonadherence leads psychiatrists to implement adherence-enhancing measures and to identify barriers and facilitators for the implementation of adherence-enhancing measures.

Methods  A cross-sectional survey was conducted with German hospital psychiatrists and their inpatients who had a diagnosis of schizophrenia or schizoaffective disorder.

Results  Interviews were conducted with 121 psychiatrists or resident psychiatrists and their 213 inpatients. Psychiatrists recognized nonadherence as an important factor for hospital admission only when directly asked about it. Psychiatrists implemented a plethora of adherence interventions that in many cases constituted only intensive talks and no structured interventions. Of four core interventions addressed in the survey—depot administration of medication, psychoeducation for patients, psychoeducation for relatives, and arrangement of first follow-up visit—the implementation rates were surprisingly high for depot prescription of antipsychotics (>30%) and psychoeducation for patients but dramatically low for arrangement of follow-up visits and psychoeducation for relatives. Patients with poor previous adherence (according to the physician’s estimate) received more adherence measures. In addition, patients with involuntary admission were more likely to receive depot medications, and psychoeducation was more often implemented for younger patients and for patients at university hospitals.

Conclusions  Treatment nonadherence is often underestimated by psychiatrists. Obstacles to the implementation of adherence-enhancing interventions occur in routine daily care. Integrated-care programs addressing adherence issues, communication between inpatient and outpatient treatment, implementation of adherence measures, and better involvement of patients in clinical decisions may help to overcome these barriers.

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Table 1Characteristics of 213 inpatients with schizophrenia or schizoaffective disorder
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a All patients spoke German well enough to understand the interviews.

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b Data missing for 4 inpatients

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Table 2Reasons for hospital admission of 213 patients with schizophrenia or schizoaffective disordera
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a Multiple answers were possible.

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Table 3Actions physicians took to improve patients’ adherence after dischargea
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a Actions (N=294) were identified from spontaneous quotations. Multiple answers were possible.

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Table 4Physicians’ reasons for not implementing four specific adherence-enhancing measures
Table Footer Note

a Multiple answers were possible.

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Table 5Physicians’ views on general barriers to implementing adherence-enhancing measuresa
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a N=117 physicians. Multiple answers were possible.

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