APA: Poor Understanding Called Biggest Barrier to Antipsychotic Drug Adherence

SAN DIEGO, May 23 -- The most common reasons patients don't adhere to antipsychotic regimens are poor insight into the nature of their illness, forgetfulness, and simply deciding to stop, surveyed physicians said.

So reported John Kane, M.D., speaking at an industry-sponsored workshop held in conjunction with the American Psychiatric Association meeting here. Dr. Kane, of Albert Einstein Medical College in New York, noted that problems with adherence are compounded in psychiatric conditions, which can affect insight, judgment, and cognition.

"The other thing that can happen is that individuals can be lulled into a false sense of security. When they're doing particularly well, they think that perhaps they don't need to take their medication," he said. "One can stop taking medication in an illness like schizophrenia and not necessarily notice a change immediately."

To tease out the most important factors behind nonadherence, a survey tool was developed through a literature review and through input from clinicians, researchers, consumers, and caregivers.

The investigators conducted a pilot study in which physicians evaluated five or fewer patients with schizophrenia by indicating "Yes" or "No" on a sample survey that asked whether the patient possessed any of 10 attributes associated with adherence issues. The physicians were also asked to rank the attributes in importance from most important (1) to least (10).

Before national distribution, the survey was revised to include eight factors with no ranking system and asking for information on 10 or fewer patients per clinician. The authors used chi-square testing to identify regional differences.

A total of 3,156 physicians and other clinicians were surveyed, including 134 in the pilot study and 3,022 in the national roll-out.

In all, 61 (46%) of the pilot program physicians returned surveys, and data on 309 patients collected from these physicians revealed that "poor insight into illness" was the most common reason given for nonadherence, reported for 74% of patients.

The same reason was cited most often in the larger analysis, which collected data on 13,538 patients from 1,522 physicians -- about a 50% return. "Poor insight into illness" was cited for 68% of patients.

Second most often cited was "previous discontinuation of medication on own," reported for 68% of patients by physicians in both the pilot and national studies. Forgetting medication was reported for 67% in the pilot study and 66% in the national survey.

On the national level, there were significant regional differences for all of the risk factors. In the pilot study, there were significant regional differences for the self-discontinuation and forgetting factors along with "stigma about taking medication" and "psychotic symptoms."

"This is an example of the kind of tool that can be helpful to physicians and to patients in identifying when there might be a problem," said Dr. Kane. "We need to understand the factors that contribute to nonadherence, and then we need to find solutions to address those problems."