Non-adherence to medication is a serious problem in the United States (US). It is associated with increased emergency department visits and hospitalizations, higher costs of care, and greater mortality. For patients with serious mental illness, including schizophrenia and other psychotic spectrum disorders, bipolar disorder, and posttraumatic stress disorder (PTSD), adherence to psychopharmacological and/or non-psychopharmacological medications is an important concern.

There are a wide range of interventions for medication adherence. Interventions that target patients include psychosocial and behavioral interventions, including cognitive behavioral therapy (CBT) and Motivational Interviewing (MI), shared decision-making, customized adherence enhancement (CAE), Adherence and Compliance Therapies, and interventions involving family members. Other interventions target providers, such as provider education and training in MI. Interventions at the organization level may involve system-level interventions, such as financial incentives or reducing economic barriers through cost sharing; blister packaging for improving patient recall and tracking; and care coordination. Other interventions implemented at the organizational level include information and communication technology, such as electronic monitoring (e-monitoring), refill reminders via telephone or short message service (SMS); or other strategies, A recent review of interventions for medication adherence in patients with chronic illness found that educational interventions and case management were consistent in improving adherence across different clinical conditions, as were clinical reminders, pharmacist-led multicomponent approaches, and reducing out of pocket expenses for patients. This review examined interventions for medication adherence in patients with depression, but did not include other serious mental illnesses.

The goal of this report is to synthesize evidence examining the effectiveness of interventions to improve medication adherence in patients with psychotic spectrum disorders, bipolar disorder, and PTSD; the effect of these interventions on patient outcomes; and the related costs and any associated intervention specific harms.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • INTRODUCTION
  • METHODS
  • RESULTS
  • DISCUSSION
  • ABBREVIATIONS TABLE
• INTRODUCTION
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION 1. ADULTS WITH PSYCHOTIC SPECTRUM DISORDER
  • KEY QUESTION 2. ADULTS WITH BIPOLAR DISORDER
  • KEY QUESTION 3. ADULTS WITH PTSD
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE BY KEY QUESTION
  • LIMITATIONS
  • DISCUSSION
  • CONCLUSION
• REFERENCES
• APPENDIX A. TECHNICAL EXPERT PANEL
• APPENDIX B. SEARCH STRATEGIES
• APPENDIX C. STUDY SELECTION: INCLUSION/EXCLUSION CRITERIA FOR TITLE/ABSTRACT REVIEW
• APPENDIX D. STUDY SELECTION: INCLUSION/EXCLUSION CRITERIA FOR FULL-TEXT REVIEW
• APPENDIX E. MEDICATION ADHERENCE OUTCOME MEASURES
• APPENDIX F. PATIENT OUTCOME MEASURES
• APPENDIX G. RISK OF BIAS: TRIALS
• APPENDIX H. RISK OF BIAS: OBSERVATIONAL STUDIES
• APPENDIX I. PEER REVIEW COMMENTS/AUTHOR RESPONSES

Suggested citation:

Kondo K, Low A, Jindai K, Mendelson A, Motu'apuaka M, Mansoor D, Judge M, Kansagara D, Freeman M, Hartung D. Interventions to Improve Pharmacological Adherence among Adults with Psychotic Spectrum Disorders, Bipolar Disorder, and Posttraumatic Stress Disorder. VA ESP Project #05-225; 2015.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Portland VA Health Care System, Portland, OR, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.