Attitudes and subjective reasons of medication compliance and noncompliance among outpatients with schizophrenia in India

Abstract

Objective: This study aims to assess the attitudes and reasons of medication compliance and noncompliance among patients with Schizophrenia attending outpatients in India and examine the prevalence and factors effecting noncompliance.Method: outpatients with schizophrenia (n=75) and their accompanying family members(n-75) were assessed using standardized tools which consist reasons of medication influences (ROMI) scale, Drug Attitude Inventory (DAI) scale, Positive and Negative Symptoms Scale (PANSS). They were also evaluated for sociodemographic details; illness related and drug related variables. Results: The prevalence of non-compliance in the selected setting is 38.7%. Majority of patients and family members had a positive attitude towards medication and treatment. Family member is able to identify the compliance status of the patient and the reasons for the noncompliance better than the patients. The reasons which are significantly correlating with compliance are ‘perceived daily benefit from medication’, ‘positive relationship with psychiatrist’, pressure from the family and health system’, ‘positive family belief towards illness and treatment’. Where as the significant reasons for noncompliance are ‘no perceived daily benefit from medications’, ‘difficulty in gaining access to treatment and medications’, financial obstacles’, ‘embarrassment or stigma related to treatment and medications’, ‘medicines currently not perceived as necessary’. The factors significantly associated with noncompliance include lower educational status, rural area of stay, adjustment difficulty with their family and spouse, previous history of non-compliance, poor insight into illness, higher positive PANSS score. The patients who gave history of hospitalization in the past are more likely to be compliant with their medication. Conclusions: The Findings strongly recommends the need to develop a standard protocol for carrying out adherence counseling to all patients. Also there is need to create a cadre for mental health nurse practitioner in outpatient and inpatients units to ensure that all patients and family members are given psycho education / adherence counseling before discharge and during follow-ups. Original work done by the author for the partial fulfillment of the post graduation programme in psychiatric nursing. Significant outcomes Majority of patients and their family member have positive attitude towards antipsychotic medications. Patients with higher positive symptoms, poor insight into the illness, rural background, lower educational status, adjustment difficulty with their family and spouse, previous history of noncompliance are more likely to be noncompliant with the medications Standard medication adherence counseling protocol need to be developed and used to ensure consistent counseling to all patients before their discharge from inpatient unit and during their follow-up