Much time, effort, and resources have been devoted to developing psychotropic drugs that are safe and effective, and that improve health outcomes. However, drugs don’t work if patients don’t take them. The articles in this 2-part Special Report look into the issue of poor adherence, particularly medication adherence, and take on some of the multiple areas where interventions may be possible. Scroll through the slides for links to each article. Also see: Special Report Intro: Problems of Poor Adherence
Many patients hope medications will help provide relief; on the other hand, they are afraid medications will harm them. An approach to pharmacotherapy that emphasizes an appreciation of patients’ sociocultural contexts is critical to addressing treatment adherence disparities and improving adherence among all patients. This article explores how motivational pharmacotherapy and motivational enhancement therapy can galvanize depressed patients to get well. See: Harnessing Patients’ Own Motivation to Engage in Pharmacotherapy
Successful culturally adapted interventions to improve adherence among Latino patients with depression and schizophrenia confirm how important it is to understand a patient’s entire sociocultural environment. Successful culturally adapted interventions to improve adherence among Latino patients with depression and schizophrenia confirm how important it is to understand a patient’s entire sociocultural environment, by gauging the most influential elements and incorporating patients’ perceptions of illness and treatment. This article reviews the psychiatrist’s role in addressing barriers to treatment adherence, with helpful case vignettes to address the challenges. See: Culture as a Factor in Adherence: Learning From Latino Experiences
In everyday life, financial incentives encourage behaviors of consumers, employees, and even physicians (pay-for-performance). Cash, refunds/rebates, or material goods and services can affect patients’ behaviors. These interventions can improve adherence to medications, which is problematic for many patients who have mental health disorders. Typically, this approach involves directly observed adherence, remote monitoring via electronic bottles, or video-recording medication consumption. In short, a number of behaviors are improved by incentive interventions. See: Financial Incentives for Adherence: Do They Pay?
Many psychiatrists have patients who they know would do better if their adherence to treatment could be optimized, and partnering with primary care providers is one way to do that. Patients commonly seen by psychiatrists with illnesses such as schizophrenia, bipolar affective disorder, and moderate to severe depressive disorder die 10 to 20 years earlier than the general population as a result of a variety of preventable causes, including cardiovascular disorders, respiratory disorders, and infectious diseases. Much of this physical health comorbidity can be better managed by specialists working in collaboration with primary care to provide earlier opportunities to make lifestyle and behavioral changes. Collaborative care can be an effective way to target suboptimal adherence, particularly given the multi-morbidities experienced by many patients with mental health disorders. See: Partnering With Primary Care Clinicians to Improve Adherence
Treatment nonadherence in psychiatric patients contributes to increased suicide rates, illness exacerbation, hospitalization, and mortality. Nonadherence affects family relationships and society as a whole by both direct costs and loss of productivity. Most experienced clinicians do not need data to convince them of the widespread nature of this problem, but some recent work illustrates how pervasive it is. The authors outline a series of strategies that can help promote adherence to the therapeutic regimen. See: Psychotherapeutic Strategies to Enhance Medication Adherence
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