Self-reported treatment adherence among psychiatric in- and outpatients. (3rd October 2018)

• Record Type: Journal Article
• Authors: Karpov, Boris; Joffe, Grigori; Aaltonen, Kari; Oksanen, Jorma; Suominen, Kirsi; Melartin, Tarja; Baryshnikov, Ilya; Koivisto, Maaria; Heikkinen, Martti; Isometsä, Erkki T.
• Is Part Of: Nordic journal of psychiatry. Volume 72:Number 7(2018)
• Page Start: 526
• Page End: 533
• Publication Date: 2018-10-03
• Subjects: Treatment adherence -- inpatients -- outpatients -- psychiatric care; Psychopharmacology -- Periodicals; Psychotherapy -- Periodicals; Psychiatry -- Periodicals; Psychiatry -- Scandinavia -- Periodicals; 616.89
• DOI: 10.1080/08039488.2018.1538387
• Languages: English
• ISSNs: 0803-9488

Abstract

Abstract: Background: Poor adherence to psychiatric treatment is a common clinical problem, leading to unfavourable treatment outcome and increased healthcare costs. Aim: The aim of this study was to investigate the self-reported adherence and attitudes to outpatient visits and pharmacotherapy in specialized care psychiatric patients. Methods: Within the Helsinki University Psychiatric Consortium (HUPC) pilot study, in- and outpatients with schizophrenia or schizoaffective disorder (SSA, n = 113), bipolar disorder (BD, n = 99), or depressive disorder (DD, n = 188) were surveyed about their adherence and attitudes towards outpatient visits and pharmacotherapy. Correlates of self-reported adherence to outpatient and drug treatment were investigated using regression analysis. Results: The majority (78.5%) of patients reported having attended outpatient visits regularly or only partly irregularly. Most patients (79.2%) also reported regular use of pharmacotherapy. Self-reported non-adherence to preceding outpatient visits was consistently and significantly more common among inpatients than outpatients across all diagnostic groups ( p < .001). Across all groups, hospital setting was the strongest independent correlate of poor adherence to outpatient visits (SSA β = –2.418, BD β = –3.417, DD β = –2.766; p < .001 in all). Another independent correlate of non-adherence was substance use disorder (SSA β = –1.555, p = .001; BD β = –1.535, p = .006; DD β = –2.258, p < .000). No other socio-demographic or clinical factor was significantly associated with poor adherence in multivariate regression models. Conclusions: Irrespective of diagnosis, self-reported adherence to outpatient care among patients with schizophrenia or schizoaffective disorder, bipolar disorder, and depression is associated strongly with two factors: hospital setting and substance use disorders. Thus, detection of adherence problems among former inpatients and recognition and treatment of substance misuse are important to ensure proper outpatient care.