Evaluation of psychotropic drug adherence among psychiatric outpatients

BACKGROUND: Non-adherence amongst psychiatric patients is identified as one of the leading causes for poor therapeutic effects. Various studies have found various reasons for non-adherent across the psychiatric illnesses. Our study aimed to evaluate medication adherence and the reasons for non-adherence among psychiatric outpatients. METHODS: The cross-sectional study was conducted in the outpatient department of Ramaiah Medical College. The study involved the use of validated medication adherence questionnaire and rating of medication influences scale. Patient's demographics and information about the existing and past treatment were collected after which the information obtained from the study was entered and analyzed. RESULTS: A total of 127 patients were recruited for the study. The mean adherence was found to be 90.48 +/- 13.94. Female patients (94.47 +/- 11.06) showed a higher preponderance of adherence than males (87.43 +/- 15.17). Patients with psychosis (93.9 +/- 10.28) and depression (93.15 +/- 9.98) was shown to have the highest adherence while patients with bipolar disorders (84.16%) had the lowest. Patients on non-benzodiazepines (83.27 +/- 14.78) and tricyclic antidepressants (82.03 +/- 24.23) had the lowest adherence whereas patients on anticraving drugs and serotonin and noradrenaline reuptake inhibitors (100%) had the highest adherence The main reasons for adherence was found to be perceived benefit from the treatment (44%), followed by relapse prevention (32%). Binary logistic regression analysis showed a positive association with gender (t=13.232, P>0.00), with perceived benefit of treatment (t=9.46, P=0.002), with pressure/force from attenders (t=3.87, P=0.049), with the effectiveness of treatment (t=4.7, P=0.03), with convenience of treatment (t=4.1, P=0.042) and global satisfaction with the therapy (t=5.3, P=0.021). CONCLUSIONS: The main reasons for adherence perceived benefit; relapse prevention; supervision by relatives; global satisfaction from the treatment while reason for nonadherence were distress associated with side effects. Counselling by the psychiatrist and clinical pharmacist pertaining to the importance of medication adherence must be conducted during patient visits to minimize the nonadherence.