Effects of Interventions by Pharmacists in Caregivers to Improve Medication Adherence and Clinical Outcomes in Patients with Schizophrenia by “Patient-Tailoring Strategies”
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Abstract
Objective: To determine the effects of interventions by pharmacists in caregivers in order to improve medication adherence and clinical outcomes in patients with schizophrenia using “patient-tailoring strategies”. Method: The study was a randomized controlled study. Subjects in the study were 108 patients with schizophrenia receiving care from the mental health clinic at Chainyai hospital. The researchers randomly assigned the subjects to a study group (N = 54) and a control group (N = 54). Those in the study group were classified according to their knowledge on schizophrenia/drug uses and motivation in drug taking in order to choose the suitable strategies of interventions for them (education or motivation strengthening). Intervention was educating caregivers on schizophrenia/drug uses in order to empower them to transfer the knowledge to patients and/or training them on how to strengthen patients’ motivation in drug use. The patients were followed up 4 times (at 0, 2, 4 and 7 months). Control group received usual care from the hospital. Results: At the end of the study, the study group had significantly higher adherence levels than the control group did (as measured by pill count 83.60±6.49% and 70.33±6.11%, respectively; P<0.001, medical appointments 100.00±0.00% and 98.70±3.70%, respectively; P=0.011, adherence questionnaire 5.22±0.72 and 3.65±0.94, respectively (out of full score 7); P<0.001). There were no differences in symptoms between groups (P=0.079), but the study group significantly had better symptoms when compared to baseline (P=0.003). In addition, the study group had significantly higher medication motivation scores (8.04±1.03 and 5.44±1.62, respectively (full score=10); P<0.001) and knowledge scores than the control group (10.09±1.14 and 7.13±1.39, respectively (full score=12); P<0.001). Quality of life in “psychosocial” and “symptoms and side-effects of medications” dimensions in the study group were significantly better than that in the control group (P<0.001 and P=0.012, respectively). Conclusion: Interventions by pharmacists in caregivers of patients with schizophrenia with “patient-tailoring strategies” improved medication adherence, clinical outcome tendencies, motivation in medication usage, knowledge, and quality of life.
Article Details
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
References
2. World Health Organization. Mental disorders [on line]. 2018 [cited Aug 25, 2018]. Available from: www.who.int/mediacentre/factsheets/fs396/en/.
3. Department of Mental Health, Ministry of Public Health. Annual report 2017 [online]. 2017 [cited Apr 1, 2018]. Available from: www.dmh.go.th/download/ Ebooks/Annual_report_2017.pdf.
4. Barkhof E, Meijer CJ, de Sonneville LM, Linszen DH, de Haan L. Interventions to improve adherence to antipsychotic medication in patients with schizophre- nia–A review of the past decade. Eur Psychiatry 2012;27:9-18.
5. Chang YT, Lee LL. The effectiveness of compliance therapy on drug attitude among schizophrenic patients: a systematic review. JBI Database System Rev Implement Rep 2015;13:213-40.
6. McIntosh AM, Conlon L, Lawrie SM, Stanfield AC. Compliance therapy for schizophrenia. Cochrane database Syst Rev 2006;3:CD003442.
7. Zygmunt A, Olfson M, Boyer CA, Mechanic D. Interventions to improve medication adherence in schizophrenia. Am J Psychiatry 2002;59:1653-64.
8. Vlasnik JJ, Aliotta SL, DeLor B. Using case management guidelines to enhance to long-term therapy. Case Manager 2005; 16: 83-5.
9. Lincoln TM, Wihelm K, Nestoriuc Y. Effectiveness of psychoeducation for relapse, symptoms, knowledge , adherence and functioning in psychotic disorders: a meta-analysis. Schizophr Res 2007; 96: 232-45.
10. Dechkong T. Motivational counseling. Bangkok: Moh -Chao-Ban Publishing House; 2012.
11. Winters KC. Brief intervention: clinician's manual. Center City: Hazelden; 2004.
12. Leucht S, Engel RR, Davis JM, Kissling W, Meyer Zur Capellen K, Schmauss M, et al. Equipercentile linking of the brief psychiatric rating scale and the clinical global impression scale in a catchment area. Eur Neuropsychopharmacol 2012;22:501-5.
13. Akesuweerapong N. Factors affecting medication nonadherence in schizophrenic patients admitted at Suansaranrom hospital [master thesis]. Bangkok: Chulalongkorn University; 2006.
14. Acosta FJ, Ramallo-Farina Y, Siris SG. Should full adherence be a necessary goal in schizophrenia? full versus non-full adherence to antipsychotic treatment. Compr Psychiatry 2014;55:33-9.
15. Chuchuay N. Effects of buddy programs on medica tion adherence in patients with schizophre- nia [minor thesis]. Songkhla: Prince of Songkla Univer- sity; 2010.
16. Jeste DV, Maglione JE. Treating older adults with schizophrenia: challenges and opportunities. Schi- zophr Bull 2013;39: 966-8.
17. Chan SKW, Hui CLM, Chang WC, Lee EHM, Chen EYH. Ten-year follow up of patients with first-episode schizophrenia spectrum disorder from an early intervention service: predictors of clinical remission and functional recovery. Schizophr Res [preprint] 2019. Available from: doi: 10.1016/j.sch res.2018.08.022.
18. Department of Disease Control. Bureau of Tuberculosis. National tuberculosis control program guidelines, Thailand, 2013. 2nd ed. Bangkok: The War Veterans Organization of Thailand; 2013.
19. Putkhao S. Factors affecting medication compliance in schizophrenic patients [master thesis]. Chiang Mai: Chiang Mai University; 1998.
20. Tantajanya P, Promtuang S, Thadsri W. Brief Inter vention [online]. 2015 [cited Mar 1, 2017]. Available from: www.drterd.com/mcmi/news/admin/Brief Intervention.pdf.
21. Farooq S, Nazar Z, Irfan M, Akhter J, Gul E, Irfan U, et al. Schizophrenia medication adherence in a resource-poor setting: randomised controlled trial of supervised treatment in out-patients for schizophre- nia (STOPS). Br J Psychiatry 2011;199:467-72.
22. Ran MS, Chan CL, Ng SM, Guo LT, Xiang MZ. The effectiveness of family intervention for patients with schizophrenia in a 14-year follow-up study in a Chinese rural area. Psychol Med 2015;45:2197-204.
23. Ran MS, Xiang MZ, Chan CLW, Leff J, Simpson P, Huang MS, et al. Effectiveness of psychoeduca- tional intervention for rural Chinese families ex-periencing schizophrenia: a randomised controlled trial. Soc Psychiatry Psychiatr Epidemiol 2003; 38: 69-75.
24.Maneesakorn S, Robson D, Gournay K, Gray R. An RCT of adherence therapy for people with schizo- phrenia in Chiang Mai, Thailand. J Clin Nurs 2007 ;16:1302-12.
25. Eticha T, Teklu A, Ali D, Solomon G, Alemayehu A. Factors associated with medication adherence among patients with schizophrenia in Mekelle, Northern Ethiopia. PloS one 2015;10:e0120560.
26. Sharif F, Shaygan M, Mani A. Effect of a psycho-educational intervention for family members on caregiver burdens and psychiatric symptoms in patients with schizophrenia in Shiraz, Iran. BMC Psychiatry 2012; 12: 48.
27. Kheirabadi GR, Rafizadeh M, Omranifard V, Yari A, Maracy MR, Mehrabi T, et al. Effects of needs-assessment–based psycho-education of schizophre- nic patients’ families on the severity of symptoms and relapse rate of patients. Iran J Nurs Midwifery Res 2014;19: 558-63.
28. Paranthaman V, Satnam K, Lim JL, Amar-Singh HS, Sararaks S, Nafiza MN, et al. Effective implementa- tion of a structured psychoeducation programme among caregivers of patients with schizophrenia in the community. Asian J Psychiatr 2010; 3: 206-12.
29. Hasan AA, Callaghan P, Lymn JS. Evaluation of the impact of a psycho-educational intervention on knowledge levels and psychological outcomes for people diagnosed with schizophrenia and their care- givers in Jordan: a randomized controlled trial. BMC Psychiatry 2015;1 5: 72-81.
30. Omranifard V, Yari A, Kheirabadi GR, Rafizadeh M, Maracy MR, Sadri S. Effect of needs-assessment-based psychoeducation for families of patients with schizophrenia on quality of life of patients and their families: a controlled study. J Educ Health Promot 2014;3:125.
31. Gassmann W, Christ O, Lampert J, Berger H. The influence of Antonovsky's sense of coherence (SOC) and psychoeducational family intervention (PEFI) on schizophrenic outpatients' perceived quality of life: a longitudinal field study. BMC Psychiatry 2013;13:10-5.
32. Endriyani L, Chien CH, Huang XY, Chieh-Yu L. The influence of adherence to antipsychotics medi- cation on the quality of life among patients with schizophrenia in Indonesia. Perspect Psychiatr Care [Preprint] 2018. Available from: doi: 10.1111/ppc. 12276.
33. Gleeson JF, Cotton SM, Alvarez-Jimenez M, Wade D, Gee D, Crisp K, et al. A randomized controlled trial of relapse prevention therapy for first-episode psychosis patients: outcome at 30-month follow up. Schizophr Bull 2013;39:436-48.
34. Karow A, Wittmann L, Schöttle D, Schäfer I, Lambert M. The assessment of quality of life in clinical practice in patients with schizophrenia. Dialogues Clin Neurosci 2014;16:185-95.
35.Michel P, Auquier P, Baumstarck K, Loundou A, Ghattas B, Lancon C, et al. How to interpret multidimensional quality of life questionnaires for patients with schizophrenia?. Qual Life Res 2015; 24: 2483-92.
