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Bipolar Medication Adherence Rates Improve With Tailored, Individualized Support
Tailoring medication adherence support to the individual needs of patients with bipolar disorder (BD) utilizing the modifiable determinants of adherence may lead to stronger therapeutic alliance, according to a recent study published in Psychological Medicine.
In this video, lead author Asta Ratna Prajapati, BPharm, MRPharmS, MBA, MSC, Mental Health Consultant Pharmacist at Norfolk and Suffolk NHS Foundation Trust, Norwich, United Kingdom, expands on the study’s clinical implications and common misconceptions on this topic. Prajapati also previews the adherence tool currently in development that will help to pinpoint patient’s unique reasons for medication non-adherence.
In the previous part 1, Prajapati examines the study’s methods and key findings including the 6 identified key factors or determinants affecting medication adherence in patients with bipolar disorder.
Read the transcript:
We were quite surprised to find some of the determinants were reported by patients, but not clinicians. As I just mentioned, forgetfulness, intentional non adherence, and emotions evoked, were only reported by patients, but not clinicians.
This was surprising given that clinicians and patients should be working together in partnership to achieve a common goal of getting patients better. Our findings suggest that clinicians may not be recognizing some of the most significant determinants of adherence. Therefore, we may not be using the appropriate strategies to address these issues.
In terms of the clinical implications, we know medicines are the cornerstone of management of bipolar disorder, but our findings suggest that there is a lot of work to do to ensure that the intended benefit of medicines are realized through good medication adherence.
As clinicians, I'm sure we all put lots of time and effort to get the right medicines at the right dose for the right patient, etc., but non adherence can waste all those efforts. In clinical practice, before changing meds or adjusting dose or saying med's not working, etc., we need to be asking whether our patients are actually taking your medicines.
If not, we need to be exploring those factors that may be leading to non adherence. The importance of these is that we can then tailor adherence support to patient depending on their unique individual barriers to adherence.
This is just one part of our bigger program of research to address medication non adherence. Following this study, we have conducted focus groups and interviews with patients and caregivers.
We have consulted many clinicians, psychologists, experts in behavior medicines, and we have now developed a tool to help clinicians identify non adherence as well as individual's barriers to adherence. We are now testing this tool with around 600 patients with bipolar disorder.
I think one of the misconceptions or misunderstandings, shall I say, sometimes we think adherence is just about patients taking whatever clinicians prescribed. This need to be corrected.
Adherence really mean clinicians and patients, working together to mutually agreeable decision about meds with common goals of getting patients better. In some instances, this means discontinuing medicines and providing non medicinal treatment, if that is the patient's strong preference and is clinically appropriate.
While as clinicians, we may be the experts in illness and treatment, patients, by nature, are the expert of their lived experience. Acknowledgement of patients worldview of the bipolar disorder and its treatment will likely lead to stronger therapeutic alliance, which in turn will help patients adhere to clinicians advice, not just related to meds, but also other recommendations like lifestyle changes.
We are very excited to develop this adherence tool, which will not only identify non adherence, but it will actually pinpoint individual patient's unique reasons of non adherence. We strongly believe that this tool will be very useful for busy clinicians in improving adherence and patient's outcome.
Thank you very much.
Reference
Asta Ratna Prajapati, BPharm, MRPharmS, MBA, MSC, is a Mental Health Consultant Pharmacist at Norfolk and Suffolk NHS Foundation Trust, Norwich, United Kingdom, and pharmacist specialist advisor for Care Quality Comission in the UK. Prajapati is currently under PhD program at the University of East Anglia, Norwich, England, where he is leading a 4-year research project called “Collaborative Medication Adherence in Bipolar disorder (C-MAB)” which aims to develop a medication adherence tool for bipolar disorder. This project is funded by Health Education England / National Institute for Health Research (UK) under Clinical Doctoral Research Fellowship program.
Prajapati has led two systematic reviews, including one meta-analysis, and has been published in various journals including in the Pharmaceutical Journal, BMJ Open, Progress in Neurology and Psychiatry, Bipolar Disorders, and Psychological Medicine.
