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Six Key Factors Affect Medication Adherence in Patients With Bipolar Disorder
A recent study identified 6 key factors or determinants affecting medication adherence in patients with bipolar disorder, such as experiencing side effects, knowledge about the disorder, and social influences. 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, discusses the study methods and key findings.
In the upcoming part 2, Prajapati examines the study’s surprising findings and clinical implications for clinicians treating patients with bipolar disorder.
Read the transcript:
Hi, I'm Asta Ratna Prajapati. I'm a consultant pharmacist at Norfolk and Suffolk Mental Health Trust, and also a postgraduate researcher at the University of East Anglia.
Currently, I'm leading a 4 year research project looking at how to improve medication adherence in bipolar disorder. This research project is funded by National Institute for Health Research in the UK. We are in the final year of this project.
As a mental health pharmacist, I know from my own clinical practice that medication adherence among bipolar disorder is very poor. Evidence suggests that over a third of people do not take their medication as prescribed. This has a significant impact on our goals to manage bipolar disorder.
As we know, medication non-adherence significantly increases the risk of relapse, risk of hospitalization, risk of suicide, and other negative outcomes. To give you an example, non-adherence can increase the risk of hospitalization by fivefold or more. However, there has not been much progress in medication adherence over the last five, six decades.
One of the reasons we think is our lack of understanding of what stopped people from taking their medications. We want to better understand the factors or determinants of medication non-adherence in bipolar disorder. As I just mentioned, this is a part of a 4-year research project funded by National Institute for Health Research in the UK.
This is a systematic review. We were looking at all published studies with explored modifiable determinants, that is those things where there is a scope for us as a clinician to intervene to modify them. For example, medication related factors. The resource team include pharmacist, psychiatric, psychologist experts in evidence synthesis and behavioral medicines from the UK, France, and the US.
We looked at many scientific databases for any relevant published literature. We found 57 studies that met our inclusion criteria. Most studies explored determinants of non-adherence, from the perspective of patients, but few studies included clinicians' perspective. Most of the studies were conducted in the US and Europe.
In terms of the most significant findings of our study, we found 6 key factors or determinants affecting adherence. Some were reported by patients only while others were reported by patients and clinicians.
Things that were important to both patients and clinicians alike were medication-related factors, such as efficacy and tolerability or side effects, patient's knowledge or beliefs about bipolar disorder and its treatment, and availability of practical or psychological support to patients.
Consistent example out of their studies is negative beliefs about myths or lack of understanding of bipolar disorder and its treatment led to non-adherence and vice versa. However, there were things like forgetfulness, change daily schedules and routines, intentional non-adherence, and emotion evoked by medications were only reported by patients and not clinicians. This is significant.
Intentional non-adherence are due to patients not accepting the bipolar disorder or denying the need for the treatment or your preference for alternative treatments such as mindfulness or psychotherapy.
Emotion, such as fear of addiction, worry about getting your personality changed, or making them feel like a zombie were quite frequently reported by patients as significant barriers to adherence, but these seems to be not recognized by clinicians in our study.
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.
