Medication
Adherence
Getting on board with the treatment
plan is often the biggest roadblock to recovery from any
kind of illness.
The former U.S. Surgeon General, C.
Everett Koop, MD, once said “Drugs don’t work in patients
who don’t take them. Medication adherence can be a real
problem in any medical condition including hypertension,
diabetes, epilepsy, asthma, and brain disorders. However,
the failure of individuals with schizophrenia and bipolar
disorder to continue taking meds is one of the most serious
issues in psychiatric care (Treatment Advocacy Center). It
is estimated that patients with schizophrenia stop
medications 40% of the time following a hospitalization
(Gorman, Jack). Furthermore, the single most common reason
for medication noncompliance is that the person does not
believe he/she is ill and has not been educated about his or
her illness. This can often be attributed to a poor
relationship between consumers and professionals (Treatment
Advocacy Center).
Other reasons for noncompliance of
psychiatric medications include:
1.
Substance Abuse
Many
physicians will encourage consumers to stop drinking alcohol
or using recreational drugs when they are taking psychiatric
medications. Therefore, people stop medications so they can
continue using these substances. Also, some medications
will counteract with substances and decrease the desired
effect of the substance.
2.
Lack of Treatment Response
It may take
several weeks before some medications produce a desired
effect. Many people misunderstand, believe the medications
are ineffective and stop taking the medications.
3.
Frequency of dosing
People may
have difficulty remembering to take several medications
several times a day and get frustrated.
4.
Severity of Illness
Studies show
a correlation between severity of illness and nonadherence
to medications. Also, if a consumer has a number of
comorbid conditions there may be a limit to how many
medications he or she is willing to take.
5.
Other contributing factors include:
·
Cost of medications
·
Increased depression usually means lower
motivation
·
Lack of access to medications
·
Purposeful stopping of medications due to the
person enjoying the feelings of mania (Treatment Advocacy
Center).
The consequences of nonadherence to
medications may be quick and debilitating. They include:
1.
Higher and faster relapses
2.
More hospitalizations
3.
Increased violence
4.
Increased negative attitudes about medications
5.
Self medication with recreational substances (Gorman,
Jack)
What can professionals do to raise the
awareness for the need for increased medication compliance?
Studies have found that improvement in
the consumer/professional relationship leads to better
adherence. Physicians and clinicians need to take time to
listen to consumers, treat them with respect, explain things
to them until all their questions are answered, and involve
consumers in their treatment plan (Treatment Advocacy
Center). Also, better education of a consumer’s illness and
the medications prescribed will help the consumer understand
and develop a therapeutic relationship. It also helps to
have a functional aftercare plan when a consumer is released
from the hospital. Plans for psychosocial interventions are
just as important as having appointments with counselors and
physicians. Lastly, decreasing the frequency of doses or
using long acting injectable medications may be helpful with
adherence (Gorman, Jack).
What can family members do?
Family members need to remember that it
is the choice of the consumer to take medications. But you
can point out the positive changes you see when your loved
one is medication compliant. And you can research the
medications he or she is taking so you can understand the
effects or side effects that may occur. Encourage the
consumer to ask questions when he/she sees a
physician/therapist.
What can consumers do?
Consumers will benefit by participating
in their treatment plans and communicating goals and
concerns to their physicians and therapists. Some
professionals may not be open to this type of
communication. If that’s the case, you, as the person most
in charge of your treatment may have to search for
professionals who will accept your input.
You should also know that consumers
generally do much better when they allow family members or
others in their support system to participate in treatment
in a positive way.
Be sure to inform your physician about
your concerns involving medications and ask if he or she can
design a medication protocol that “fits” for you. Remember,
medications and therapy are very important factors in
promoting recovery.
Enjoy the warmth of Spring!
Carol Ziolo, RN, LCPC
