The poor therapeutic adherence of patients with schizophrenia is one of the biggest obstacles faced by mental health specialists today. And, although the antipsychotic treatment for schizophrenia has advanced a lot in recent years, both for the approach of the acute episodes, as for the relapse preventionIn clinical practice, the important benefits that treatment has shown in clinical trials have not been reflected.
Aware of the obstacle posed by the lack of therapeutic adherence in the approach to schizophrenia, doctors José Manuel Montes, of the Department of Psychiatry of the Hospital del Sureste, in Madrid, and Jerónimo Saiz-Ruiz, of the Department of Psychiatry of the Ramón University Hospital and Cajal de Madrid, together with researchers from the Medical Department of AstraZeneca, have carried out a study of therapeutic adherence with nursing telephone follow-up that was just published in the magazine Clinical Practice & Epidemiology in Mental Health.
The main conclusion of the study, as explained by Dr. Montes, is that "the telephone intervention was not only effective to improve adherence, but was especially effective in those patients who previously had a bad attitude towards medication antipsychotic, four times more likely to respond than the group of patients who, initially, had a good perception of the treatment. "
The study, which involved 198 mental health centers throughout Spain, included 865 patients over 18 years of age, diagnosed with schizophrenia, stable and taking a single oral antipsychotic drug. The patients were divided into two groups: one, the one who received the intervention, which consisted of a phone call from a mental health nurse at 4, 8 and 12 weeks after starting the study and, another, the control group, in that patients were simply cited for a consultation four months after their inclusion in the study. Each telephone call consisted of a brief assessment of therapeutic adherence (a series of questions about the knowledge of the treatment regimen, about the dose and compliance, or not, of it).
Thus, the study showed that "a significantly high percentage of patients in the intervention group improved adherence to treatment at the end of the study compared to the control group (25.7% vs. 16.8%)", explains Dr. Montes. In this case, it should also be noted that most of the patients who started the study also completed it. "This confirms that the patients themselves saw the usefulness of monitoring, not only at first, but throughout the study."
The study also suggests that telephone intervention improves the perception of antipsychotic treatment in some patients and that, in those patients who improved adherence without improving their attitude towards medication, the intervention acts as a reminder, increasing the number of days patients they take the medication as prescribed.
Lack of adherence to treatment, a big problem
"If the patient does not comply with the treatment, the disease will go on and there will be a new relapse, with a re-entry and all this implies back in the disease"
Mental health specialists recognize that the problem of adherence to treatment in schizophrenia is one aspect that still needs to be advanced. In Spain, a percentage higher than 50-60% of patients with schizophrenia do not have a therapeutic adherence that can be considered adequate, that is, that allows them to be effective in medication and helps them to improve and prevent relapse. Lack of adherence to treatment is associated with poorer clinical outcomes, with an increase in the use of psychiatric emergency services and with an increase in the number of hospitalizations. "If the patient does not comply with the treatment," Dr. Montes explains, "the disease will continue and will have a new relapse, with a new re-entry and with everything that implies back in the disease",
By improving adherence, the disease can be stopped and psychosocial rehabilitation, which is as necessary as pharmacological treatment in these patients, can continue, so that there will be no relapse and the patient will continue to improve the aspects residuals of the disease.
Therefore, Dr. Montes concludes, "we should not focus exclusively on prescribing a treatment, but we must make an effort so that the patient continues taking that treatment. Thanks to that we have a healthcare network adequate, with simple and inexpensive measures such as a phone call, we can track the adherence in a closer way.We already know that with a measure as simple and economic as this one can achieve a great performance ".