Medication adherence in crisis?

Abstract

Aims and method: We examined rates of medication non-adherence in 172 referrals to a crisis resolution home treatment service; we then explored any association between pattern of adherence and the treatment interventions recommended.

Results: Thirty percent of crisis referrals (95% confidence intervals (CI) 24%, 38%) reported sub-optimal medication adherence in the preceding month. These individuals were significantly more likely to have a dual diagnosis (odds ratio 2.9, 95% CI 1.4, 5.9) and assessment was significantly more likely to be followed by admission (odds ratio 2.5; 95% CI 1.0, 6.2); non-adherence remained a significant predictor of admission when the odds were adjusted for confounders (odds ratio 1.18; 95% CI 1.0, 1.3).

Clinical implications: Clinicians need to proactively identify and manage non-adherence as it is a potentially preventable trigger of relapse often present for months rather than days prior to the index crisis referral. Non-adherence is a meaningful target for improving clinical and cost-effectiveness of general adult mental health services.

Keywords:

• Mental health
• medication adherence
• crisis services
• admissions
• dual diagnosis

Acknowledgments

Professor Scott and Dr. Tacchi have received unrestricted educational grants from Astra Zeneca to deliver and evaluate a multi-disciplinary training programme in adherence therapy and from Jason-Cilag to explore attitudes and beliefs about medication in patients receiving oral and depot medications.