Abstract
Objective
Medication compliance is an orphan topic. Training in the understanding and management of noncompliance does not neatly fall within the domain of psychopharmacology, nor does it clearly fit into other core curricula areas, such as clinical interviewing or psychotherapy training. The objective of this article is to increase awareness about this vagueness among academic psychiatrists and to offer a suggested curriculum to facilitate implementation.
Methods
The authors present a curriculum covering major aspects of the theory and practice of compliance. The proposed curriculum is divided into five core components that can be used together or separately. These components are: 1) definition of compliance and noncompliance; 2) understanding how compliance depends on efficacy; 3) assessment of compliance and noncompliance; 4) the importance of the therapeutic alliance; and 5) pharmacological and psychosocial strategies to improve compliance. These five sections can be modified into specific lectures that are added to ongoing psychopharmacology, psychiatric interviewing or psychotherapy courses.
Results
A careful review of the American Board of Psychiatry and Neurology (ABPN) core curriculum found no mention of medication compliance/adherence as a specific training goal, and our residency program like many others did not have a specific course that focused on this issue. To address this omission, the authors designed and taught a five-session course for PGY-III and PGY-IV psychiatry residents that specifically addressed assessment and management of noncompliance. It was piloted in the 2003–2004 academic year. The course was very well received and formed the basis of this material presented in this review and discussion.
Conclusion
The principles of understanding, assessing, and managing medication compliance should be a part of the core curriculum for every psychiatric residency training program.
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References
Horwitz RI, Horwitz SM: Adherence to treatment and health outcomes. Archives of Internal Med 1993; 153: 1863–1868
Lerner BH, Gulick RM, Dubler NN: Rethinking nonadherence: historical perspectives on triple-drug therapy for HIV disease. Annals of Internal Med 1998; 129: 573–578
Johnson DAW: Further observations on the duration of depot neuroleptic maintenance therapy in schizophrenia. Br J Psychiatry 1979; 135: 524–530
Pampallona S, Bollini P, Tibaldi G, et al: Patient adherence in the treatment of depression. Br J Psychiatry 2002; 180: 104–109
Sajatovic M, Davies M, Hrouda DR: Enhancement of treatment adherence among patients with bipolar disorder. Psychiatr Serv 2004; 55: 264–269
Weiden P, Olfson M. Cost of relapse in schizophrenia. Schizophrenia Bulletin 1995;21: 419–428
Weiden P: Psychopharmacologic management of noncompliance in schizophrenia. J Practical Psychiatry and Behavioral Health 1997; 3: 239–245
Zygmunt A, Olfson M, Boyer CA, et al: Interventions to improve medication adherence in schizophrenia. Am J Psychiatry 2002; 159: 1653–1664
Velligan DI, Prihoda TJ, Ritch JL, et al: A randomized singleblind pilot study of compensatory strategies in schizophrenia outpatients. Schizophrenia Bulletin 2002;28: 283–292
Neurology ABoP. Psychiatry and Neurology Core Competencies Version 4.1; 2004
Haynes RB, Taylor DW, Sackett DL: Compliance in health care. Baltimore: Johns Hopkins University Press; 1979
Weiden PJ, Kozma C, Grogg A, et al: The relationship between medication compliance and hospitalization in patients with schizophrenia: a retrospective review of the california medicaid database. Psychiatr Services 2004; 55: 886–891
Cramer J, Mattson R, Prevey M, et al: How often is medication taken as prescribed? A novel assessment technique. JAMA 1989; 261: 3273–3277
Schooler NR, Levine J, Severe JB, et al: Prevention of relapse in schizophrenia: An evaluation of fluphenazine decanoate. Archives of General Psychiatry 1980; 37: 16–24
Norell SE: Accuracy of patient interviews and estimates of clinical staff in determining medication compliance. Soc Science and Med 1981; 15: 57
Barofsky I: Compliance, adherence, and the therapeutic alliance: steps in the development of self-care. Soc Science and Med 1978; 12: 369–376
Grunebaum MF, Weiden PJ, Olfson M: Medication supervision and adherence of persons with psychotic disorders in residential treatment settings: A pilot study. J Clin Psychiatry 2001; 62: 394–399
Blackwell Scientific B: Treatment adherence. Am J Psychiatry 1976; 129: 513–531
Perkins DO: Predictors of noncompliance in patients with schizophrenia. J Clin Psychiatry 2002; 63: 1121–118
Fenton W, Blyler C, Heinssen R. Determinants of medication compliance in schizophrenia: Empirical and clinical findings. Schizophrenia Bulletin 1997;23: 637–651
Frank AF, Gunderson JG: The role of the therapeutic alliance in the treatment of schizophrenia. Archives of General Psychiatry 1990; 47: 228–235
Jamison KR, Akiskal HS: Medication compliance in patients with bipolar disorder. pcna 1983; 6: 175–192
Jamison K. Lithium compliance in manic-depressive illness. In: Blackwell Scientific B, Ed. Treatment compliance and the therapeutic alliance. 5 vol. Amsterdam: Harwood Academic Press Publishers; 1996: 251–275
Tuma A, May P, Yale C, et al: Therapist characteristics and outcome of treatment of schizophrenia. Archives of General Psychiatry 1978; 35: 81–85
Corrigan PW, Liberman RP, Engel JD: From noncompliance to collaboration in the treatment of schizophrenia. Hosp and Community Psychiatry 1990; 41: 1203–1211
Blaska B: The myriad medication mistakes in psychiatry: A consumer’s view. Hosp and Community Psychiatry 1990; 41: 993–998
Blackwell Scientific B, Griffin B, Magill M: Teaching medical students about treatment compliance. J Med Education 1978; 53: 672
Rao NR, Meinzer AE, Berman SS: Countertransference: Its continued importance in psychiatric education. J Psychotherapy Practice and Res 1997; 6: 1–11
Soumerai S, McLaughlin TJ, Ross-Degnan D, et al: Effects of limiting medicaid drug-reimbursement benefits on the use of psychotropic agents and acute mental health services by patients with schizophrenia. New England J Med 1994; 331: 650–655
Goldfinger SM, Hopkin JT, Surber RW: Treatment resisters or system resisters?: toward a better service system for acute care recidivists. New Directions in Ment Health Services 1984; 21: 17–27
Eisenthal S, Emery R, Lazare A, et al: Adherance and the negotiated approach to patienthood. Archives of General Psychiatry 1979; 36: 393–398
Hall JA, Dornan MC: What patients like about their medical care and how often they are asked: A meta-analysis of the satisfaction literature. Soc Science and Med 1988; 27: 935–939
Moran AE, Freedman RI, Sharfstein SS: The journey of sylvia frumpkin: A case study for policy makers. Hosp and Community Psychiatry 1984; 35: 887–893
Palardy N, Greening L, Ott J, et al: Adolescents’ health attitudes and adherence to treatment for insulin-dependent diabetes mellitus. Developmental and Behavioral Pediatrics 1998; 19: 31–37
Williams GC, Ryan RM, Rodin GC, et al: Autonomous regulation and long-term medication adherence in adult outpatients. Health Psychol 1998; 17: 269–276
Fishbein M, Ajzen I. Belief, Attitude, Intention and Behavior. Reading,Mass; 1975
Becker MH: Patient adherence to prescribed therapies. Med Care 1985; 23: 539–555
Becker MH, Maiman LA. Strategies for enhancing patient compliance. J Community Health 1980;6: 113–135
Haynes RB, Sackett DL, Taylor DW. How to detect and manage low patient compliance in chronic illness. Geriatrics 1980;35: 91–93, 96–97
Haynes RB, Sackett DL, Gibson ES, et al: Improvement of medication compliance in uncontrolled hypertension. Lancet 1976; 1: 1265–1268
Haynes RB, Sackett DL, Taylor DW, et al: Manipulation of the therapeutic regimen to improve compliance: conceptions and misconceptions. Clin Pharmacol Ther 1977; 22: 125–130
Weiden PJ, Rapkin B, Mott T, et al: Rating of medication influences (ROMI) scale in schizophrenia. Schizophrenia Bulletin 1994;20: 297–310
Weiden PJ: Understanding depot therapy in schizophrenia. J Practical Psychiatry and Behavioral Health 1995; 1: 182–184
Weiden P, Mackell J, MacDonell D. Obesity as a risk factor for antipsychotic noncompliance. Schizophrenia Research 2003:in press.
Viguera AC, Baldessarini RJ, Hegarty JD, et al: Clinical risk following abrupt and gradual withdrawal of maintenance neuroleptic treatment. Archives of General Psychiatry 1997; 54
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Weiden, P.J., Rao, N. Teaching Medication Compliance to Psychiatric Residents: Placing an Orphan Topic Into a Training Curriculum. Acad Psychiatry 29, 203–210 (2005). https://doi.org/10.1176/appi.ap.29.2.203
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DOI: https://doi.org/10.1176/appi.ap.29.2.203