Terminology[ edit ] In medicine, compliance synonymous with adherence, capacitance describes the degree to which a patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance, but it can also apply to medical device use, self careself-directed exercises, or therapy sessions. Both patient and health-care provider affect compliance, and a positive physician-patient relationship is the most important factor in improving compliance,  As ofUS health care professionals more commonly used the term "adherence" to a regimen rather than "compliance", because it has been thought to reflect better the diverse reasons for patients not following treatment directions in part or in full. In this context, the patient is informed about their condition and treatment options,involved in the decision as to which course of action to take, and partially responsible for monitoring and reporting back to the team.
Psychiatrists may unnecessarily discontinue medications, increase doses, or add concomitant medications to address what appears to be a poor medication response in a patient who actually has an adherence problem.
Inadvertent nonadherence occurs when signs or symptoms get in the way of taking medication eg, cognitive deficits prevent the organization necessary to maintain compliance.
Intentional nonadherence results from a conscious decision on the part of the patient to discontinue his or her medication. Different interventions may be needed to address these different types of nonadherence.
A number of review articles have summarized the data on interventions to improve adherence to medications.
Environmental supports and cognitive adaptation training Using environmental supports to cue and reinforce the taking of medication has been found to be among the most effective strategies for persons with physical illnesses.
Our research group has developed a systematic approach to using environmental supports for patients with schizophrenia, known as cognitive adaptation training CAT. CAT treatment plans are based on a comprehensive assessment of cognitive functioning, adaptive functioning, and the environment.
CAT interventions for medication adherence include large calendars with pens attached to track appointments; signs; medication containers with alarms to prompt the taking of medication; labeled single-dose containers to prevent the taking of extra medication doses; bus passes to assist patients in getting to the clinic for scheduled appointments; and notebooks for recording side effects for discussion with the doctor at the next clinic visit Table.
In a number of reports, CAT has been found to improve symptomatology and adaptive functioning and to reduce rates of relapse for schizophrenic outpatients in comparison with standard care and control conditions. The monitor can also ask a number of questions about side effects or symptoms on a regular basis by displaying questions on an LCD screen.
Moreover, if a problem in adherence is identified by providers who are monitoring the Web site, they can contact the patient to identify barriers to adherence, apply problem-solving techniques, and remind the patient of important personal goals achieved by taking medication as prescribed.
The monitor device is shown in Figure 2. There are, of course, some limitations in the use of environmental supports with individuals who have serious mental illness; some supports may not be acceptable to some patients. Because of difficulties in generalization of behavior, patients may be best trained in the use of devices and supports in the home environment.
In addition, in intervention programs that use devices such as cell phones and pagers, some patients may sell or trade these devices. Despite these limitations, when used appropriately, environmental supports can improve a range of outcomes, including adherence to medication regimens.
Case 1 Mary is a year-old woman who had schizophrenia diagnosed about 15 years ago. While she responds to antipsychotic medications, she continues to experience hallucinations many times during the day and remains afraid of people when she is out in public.
Mary stated that she sometimes forgot to take medication before leaving for her psychosocial treatment program.
In addition, she reported that she would sometimes remember her evening dose of medication after she was already in bed and was often too tired to get up and take the dose. The monitor was placed by her bed and was set so that the alarm would sound 20 minutes before Mary left for her therapy program and later in the day for her evening dose.
If Mary was too tired to leave her bed to take medication when the alarm sounded at night, she had only to reach as far as her nightstand for her medication and the water needed to swallow it.
The monitor was programmed to remind Mary to restock the water on her nightstand on a regular basis. Treatment providers in her day program noticed a dramatic improvement in her positive symptoms and her willingness to socialize with others.
They wanted to know how we had changed her medication regimen to achieve such an effect. This issue may explain, at least in part, the finding that patient psychoeducation alone has little or no effect on improving medication adherence in schizophrenia.
Cognitive-behavioral therapy CBT is considered to be an evidence-based practice and is a recommended treatment for schizophrenia in the United Kingdom. Many of the same CBT principles used for anxiety and depressive disorders have been modified and adapted to the symptoms of schizophrenia.
Studies have demonstrated the efficacy of CBT for reducing symptomatology and rates of relapse in patients with schizophrenia. · Using A Pharmacy-Based Intervention To Improve Antipsychotic Adherence Among Patients With Serious Mental Illness Authors Marcia Valenstein, Janet Kavanagh, Todd Lee, Peter Reilly, Gregory W.
Dalack, John Grabowski, David initiativeblog.com?article=&context. · Improving compliance rates Role of health care providers. Health care providers play a great role in improving adherence issues.
Providers can improve patient interactions through motivational interviewing and active listening.
Health care providers should work with patients to devise a plan that is meaningful for the patient's initiativeblog.comology · Compliance factors · Improving compliance rates · See alsoinitiativeblog.com(medicine).
· Suboptimal adherence to antipsychotic medications plays a major role in determining the frequent relapse and rehospitalization that is characteristic of schizophrenia .initiativeblog.com · treatment, for educating patients, improving medication adherence, motivating health behavior and self-care, and disease monitoring in the home have been developed, with many of these programs demonstrated to be effective (T Bickmore & Giorgino, ;initiativeblog.com /publications/initiativeblog.com · New ways to address medication adherence problems in patients with schizophrenia offer the hope of better treatment outcomes.
Two new and promising approaches for individuals with schizophrenia are the use of environmental supports and cognitive adaptation training and cognitive-behavioral initiativeblog.com adherence-antipsychotic-medications/ /1.
· Improving adherence to antipsychotic medications could reduce the annual cost of schizophrenia to the states by $ net of the increased expense for the medications initiativeblog.com