Abstract
Adherence to prescribed medication regimes improves outcomes for patients with severe mental illness such as schizophrenia or bipolar disorders. The aim of this systematic review and meta-analysis was to compare the effectiveness among interventions to improve medication adherence in patients with schizophrenia or bipolar disorders. Literature published in the last decade was searched for interventions studies to improve adherence in patients with schizophrenia or a bipolar disorder. Interventions were categorised on the basis of type, and the context and effectiveness of the interventions were described. Two review authors independently extracted and assessed data, following criteria outlined by the Cochrane Handbook for Systematic Reviews of Interventions. The GRADEPro (McMaster University, 2020, Ontario, Canada) was used for assessing the quality of the evidence. Twenty-three publications met the selection criteria. Different types of interventions aiming to improve adherence were tested: educational, behavioural, family-based, technological, or a combination of previous types. Meta-analysis could be performed for 10 interventions. When considered separately by subgroups on the basis of intervention type, no significant differences were found in adherence among interventions (p = 0.29; I2 = 19.9%). This review concluded that successful interventions used a combination of behavioural and educational approaches that seem easy to implement in daily practice.
Highlights
Psychiatric disorders are a public health challenge and comprise 13% of the total global disease burden [1]
Reasons for exclusion were: full text was unavailable (n = 7), studies did not contain any data on adherence (n = 23), including other study populations (n = 2), no interventional study design (n = 8) and segmented publications (n = 2)
3 Downgraded due to high risk of bias for allocation concealment, blinding of participants and outcome assessors or both. This is the first systematic review providing a synthesis of the effectiveness of interventions improving medication adherence in patients with schizophrenia or bipolar disorders, including a meta-analysis
Summary
Psychiatric disorders are a public health challenge and comprise 13% of the total global disease burden [1]. Schizophrenia and bipolar disorders are severe major psychiatric disorders, with schizophrenia affecting about 23 million people and bipolar disorders affecting about 60 million people worldwide [2]. Together with psycho-education, pharmacotherapy is often the first line of treatment of these major psychiatric disorders. Maintaining medication adherence is crucial [3,4,5,6]. Varieties of risk factors for disease relapse have been reported, including medication non-adherence, substance abuse and stressful life events. Non-adherence appeared to be the strongest predictor for relapse. Discontinuing antipsychotic pharmacotherapy increased the risk of relapse by almost five times [8]
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