Abstract
BackgroundPoor adherence to antipsychotic medication is a widespread problem, and the largest predictor of relapse in patients with psychosis. Electronic reminders are increasingly used to improve medication adherence for a variety of medical conditions, but have received little attention in the context of psychotic disorders. We aimed to explore the feasibility and acceptability of including short message service (SMS) medication reminders in the aftercare plan of service users discharged from inpatient care on maintenance antipsychotic medication.MethodsWe conducted a cross-sectional, trust-wide survey in the inpatient units of the Oxleas National Health Service (NHS) Foundation Trust in the UK between June 29 and August 3, 2012. Using a self-report questionnaire and the Drug Attitude Inventory, we examined inpatient attitudes towards antipsychotic drugs, past adherence to antipsychotic medication, frequency of mobile phone ownership, and interest in receiving SMS medication reminders upon discharge from the ward. Predictors of a patient’s interest in receiving electronic reminders were examined using simple logistic regression models.ResultsOf 273 inpatients, 85 met eligibility criteria for the survey, showed decisional capacity, and agreed to participate. Of the 85 respondents, over a third (31-35%) admitted to have forgotten to take/collect their antipsychotic medication in the past, and approximately half (49%) to have intentionally skipped their antipsychotics or taken a smaller dose than prescribed. Male patients (55%), those with negative attitudes towards antipsychotics (40%), and those unsatisfied with the information they received on medication (35%) were approximately 3 to 4 times more likely to report past intentional poor adherence. The large majority of respondents (80-82%) reported having a mobile phone and knowing how to use SMS, and a smaller majority (59%) expressed an interest in receiving SMS medication reminders after discharge. No variable predicted a patient’s interest in receiving electronic reminders of antipsychotics.ConclusionsAutomatic SMS reminders of antipsychotic medication were acceptable to the majority of the survey respondents as an optional service offered upon discharge from inpatient care. Automatic electronic reminders deserve further investigation as a flexible, minimally invasive, cost-effective and broadly applicable tool that can potentially improve antipsychotic adherence and clinical outcomes.
Highlights
Poor adherence to antipsychotic medication is a widespread problem, and the largest predictor of relapse in patients with psychosis
We report on a Trust-Wide survey conducted in the inpatient units of the Oxleas National Health Service (NHS) Foundation Trust, which addressed the above questions
All participants met the following inclusion criteria: 1) They were receiving regular doses of oral antipsychotic medication, which would be prescribed upon discharge, 2) they demonstrated psychological, social and occupational functioning equivalent to a score of >50 in the Global Assessment of Functioning (GAF) Scale [28], 3) they were able to read and understand English, 4) they demonstrated decisional capacity based on the administration of the University of California, San Diego Brief Assessment of Capacity to Consent (UBACC) scale [29], and 5) they provided written informed consent for the study
Summary
Poor adherence to antipsychotic medication is a widespread problem, and the largest predictor of relapse in patients with psychosis. Electronic reminders are increasingly used to improve medication adherence for a variety of medical conditions, but have received little attention in the context of psychotic disorders. Much of the burden psychotic disorders place on patients, carers, the health service and society, is the result of relapses, which typically disrupt psychosocial and vocational adjustment, and increase the risk of hospitalisation and suicide [6]. A substantial proportion of patients (35-75%) discontinue their antipsychotic medication within 1-2 years of follow-up, a further subgroup are only partially adherent, and only a minority (8-33%) are fully adherent to treatment [10,11,12,13,14]. Poor adherence to antipsychotic medication is the largest predictor of relapse in patients with psychosis [15]
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