Self-reported treatment adherence among psychiatric in- and outpatients

Abstract

Background: Poor adherence to psychiatric treatment is a common clinical problem, leading to unfavourable treatment outcome and increased healthcare costs.

Aim: The aim of this study was to investigate the self-reported adherence and attitudes to outpatient visits and pharmacotherapy in specialized care psychiatric patients.

Methods: Within the Helsinki University Psychiatric Consortium (HUPC) pilot study, in- and outpatients with schizophrenia or schizoaffective disorder (SSA, n  =  113), bipolar disorder (BD, n  =  99), or depressive disorder (DD, n  =  188) were surveyed about their adherence and attitudes towards outpatient visits and pharmacotherapy. Correlates of self-reported adherence to outpatient and drug treatment were investigated using regression analysis.

Results: The majority (78.5%) of patients reported having attended outpatient visits regularly or only partly irregularly. Most patients (79.2%) also reported regular use of pharmacotherapy. Self-reported non-adherence to preceding outpatient visits was consistently and significantly more common among inpatients than outpatients across all diagnostic groups (p < .001). Across all groups, hospital setting was the strongest independent correlate of poor adherence to outpatient visits (SSA β = –2.418, BD β = –3.417, DD β = –2.766; p < .001 in all). Another independent correlate of non-adherence was substance use disorder (SSA β = –1.555, p = .001; BD β = –1.535, p = .006; DD β = –2.258, p < .000). No other socio-demographic or clinical factor was significantly associated with poor adherence in multivariate regression models.

Conclusions: Irrespective of diagnosis, self-reported adherence to outpatient care among patients with schizophrenia or schizoaffective disorder, bipolar disorder, and depression is associated strongly with two factors: hospital setting and substance use disorders. Thus, detection of adherence problems among former inpatients and recognition and treatment of substance misuse are important to ensure proper outpatient care.

Keywords:

• Treatment adherence
• inpatients
• outpatients
• psychiatric care

Acknowledgements

We thank MD, PhD, Prof. Jaana Suvisaari and Lic psychologist Petri Näätänen for their contributions to the HUPC project concerning online survey and self-report instruments.

Disclosure of interests

The authors declare that there is no conflict of interest.

Additional information

Funding

The Helsinki University Consortium has been supported by a grant from the Helsinki University Hospital [TYH 2016217].