Encouraging Medication Compliance in Patients

Tuesday, October 23rd, 2012

In the conclusion of his 2007 article published in Psychiatric Times entitled, “Understanding Medication Discontinuation in Depression,” Dr Alex J. Mitchell stated, “both partial non-adherence and discontinuation [of antidepressant medications] can be helped by enhanced collaborative care for depression.” These findings have continued to find support in the conclusions of a growing body of research seeking to improve treatment outcomes and reduce the direct and indirect costs of depression. While most of the major findings have come from studies focusing on treatment of depression in the primary care setting, our own observations have been that many of the problems associated with low rates of adherence and high rates of discontinuation are common to other treatment settings and providers.

In the years since PsychCoverage first began providing after-hours and vacation coverage for psychiatrists, we’ve had the opportunity to interact with many patients in the initiation phase of treatment. We have learned from them that despite the education they’ve received through the Informed Consent process and the additional education and coaching they’ve received from their treating psychiatrist, the early onset of side effects or the delayed onset of efficacy requires reinforcement of that initial education, and many times additional support is indicated, particularly in the initiation phase.

In their comprehensive literature review, Dr Mitchell’s team found that among the most promising interventions that improved medication compliance were those that involved access: follow-up, support and encouragement. We have found these interventions to be highly effective in reducing the avoidable anxiety induced by not being able to answer the simple question, “what is happening to me?” These types of patient calls account for nearly 40-50% of the after-hours clinical calls we receive at PsychCoverage. This experience has immeasurably improved our own understanding of what can be accomplished simply by having a trained RN Care Manager available to calmly de-escalate the patient, answer questions and try to re-frame the commonly held belief that they are headed in the wrong direction by continuing to take their medications.