Treatment adherence

What is treatment adherence? 

Treatment adherence involves taking prescribed treatments (both pharmaceutical and psychosocial) as recommended by the treating physician.

What is the evidence for treatment adherence?

Moderate quality evidence finds the rate of treatment non-adherence in people with schizophrenia varies between 23% and 49%, with the dropout rate from psychosocial treatments being lower, around 13%. However, moderate to low quality evidence finds no differences in the rates of refusal of treatment or premature termination of treatment between people offered antipsychotics alone and people offered antipsychotics plus psychotherapy. There were also no differences in adherence rates between people of different ethnic backgrounds.

Better treatment adherence is associated with better clinical and service utilisation outcomes, and better economic outcomes, with the cost of re-hospitalisation due to non-adherence ranging from US$1,392 million to US$1,826 million in 2005 alone.

Factors associated with non-adherence include having a longer duration of untreated psychosis, poor insight, increased psychopathology, negative attitude towards medication, previous treatment non-adherence, poor alliance with clinicians, low outpatient contact, inadequate discharge planning, being young, being male, having low social functioning, having a history of substance abuse, having depression or anxiety symptoms, long hospital stays, being married, and having cognitive impairment. Factors associated with increased treatment adherence include having previous psychiatric contacts, family support, good social functioning, living alone/being single, high education, good therapeutic alliances, facilities for follow up appointments, lower dosage frequency, and positive attitudes towards medication.

Subjective methods such as patient self-report, clinical provider report, significant other report, and chart review are more commonly used in studies as measures of treatment adherence than objective measures such as pill count, blood or urine analysis, electronic monitoring, and electronic refill records.

April 2019

Last updated at: 2:45 am, 18th April 2019
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