Novel delivery vehicles, including computerized decision tools, electronic monitoring and feedback, electronic pill cap reminder devices, SMS, and telemonitoring have been studied with promising but mixed results, leading to questions about whether these delivery vehicles are suitable for all patients, and whether they indeed lead to long-term improvements in adherence.4

Financial incentives may be effective as a strategy to improve adherence. A meta-analysis of 15 studies concluded that “financial reinforcement interventions hold potential for improving medication adherence and may lead to benefits for both patients and society.”15 However, this approach raises some ethical concerns, including “dilemmas around fairness and potential coercion,” the “value of medication, source of funding, and how patients would use the money.”16 Further studies are under way to investigate these issues.

Medication monitoring/environmental supports (e.g., Cognitive Adaptation Training, assertive community treatment) are especially important for patients who lack routines or have cognitive deficits.8

Multidisciplinary collaboration between primary care providers, psychiatrists, pharmacists, social workers, and others involved in the patient’s care facilitates addressing the clinical, social, practical, financial, and logistical barriers to adherence.

Conclusion

The authors encourage a “strong alliance between patient and psychiatrist” that enables patients to develop an “accurate model of their illness and treatment.”4 Clinicians should remember that “medication is not the sole focus of a mental health intervention”9 and must be only one component of a larger, holistic approach.

References

1. Trivedi MH, Lin EH, Katon WJ. Consensus recommendations for improving adherence, self-management, and outcomes in patients with depression. CNS Spectr. 2007;12(8 Suppl 13):1-27.

2. Lacro JP, Dunn LB, Dolder CR. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry. 2002;63(10):892-909.

3. Gadkari AS, McHorney CA. Unintentional non-adherence to chronic prescription medications: how unintentional is it really? BMC Health Serv Res. 2012;12:98.

4. Chapman SC, Horne R. Medication nonadherence and psychiatry. Curr Opin Psychiatry. 2013;26(5):446-552.

5. Lee KC. Improving medication adherence in patients with severe mental illness. Pharmacy Today. 2013;19(6):69-80.

6. Mitchell AJ, Selmes T. Why don’t patients take their medicine? Reasons and solutions in psychiatry. Advances in Psychiatric Treatment. 2007;13:336-346.

7. Treatment Advocacy Center. Why individuals with severe psychiatric orders often do not take their medications-Backgrounder. (2011) Available at: http://www.treatmentadvocacycenter.org/resources/consequences-of-lack-of-treatment/anosognosia/1375 Accessed: August 22, 2013.

8. Velligan DI, Weiden PJ, Sajatovic M, et al. Strategies for addressing adherence problems in patients with serious and persistent mental illness: recommendations from the expert consensus guidelines.  J Psychiatr Pract. 2010 Sep;16(5):306-324.

9. Chaplin R. How can clinicians help patients take their psychotropic medications? Advances in Psychiatric Treatment. 2007;13:347-349.

10. Ehret MJ, Wang M. How to Increase Medication Adherence: What Works? Ment Health Clin. 2013;2(8):11. Available at: http://cpnp.org/resource/mhc/2013/02/how-increase-medication-adherence-what-works. Accessed: September

11. Foster A, Sheehan L, Johns L. Promoting treatment adherence in patients with bipolar disorder. Curr Psychiatry. 2011;10(7):45-52.

12. Bisbee CC, Vickar GM. A Review of Psychoeducation for Patients with Schizophrenia. Psychiatric Annals. 2012;42(6):205-210.

13. Treasure J. Motivational interviewing. Advances in Psychiatric Treatment. 2004;10:331-337.

14. Possidente CJ, Bucci KK, McClain, WJ. Motivational interviewing: A tool to improve medication adherence? Am J Health-Syst Pharm. 2005; 62:1311-1314.

15. Petry NM, Rash CJ, Byrne S, et al. Financial reinforcers for improving medication adherence: findings from a meta-analysis. Am J Med. 2012;125(9):888-896.

16. Priebe S, Sinclair J, Burton A, et al. Acceptability of offering financial incentives to achieve medication adherence in patients with severe mental illness: a focus group study. J Med Ethics. 2010;36(8):463-468.