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Treatment Nonadherence (treatment + nonadherence)
Selected AbstractsFactors associated with treatment nonadherence among US bipolar disorder patients,HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 2 2008Ross J. Baldessarini Abstract Objective Since sustained treatment-adherence is often problematic and may limit clinical outcomes among bipolar disorder (BPD) patients, we sought risk factors to guide clinical prediction of nonadherence. Methods Data were from a 2005 US national sample providing questionnaire responses by 131 randomly selected prescribing psychiatrists and their adult BPD patients. We contrasted demographic and clinical factors in treatment-adherent versus nonadherent patients (strictly defined as missing ,1 dose within 10 days) in univariate analyses followed by multivariate logistic-regression modeling. Results Of 429 DSM-IV BPD patients (79% type-I; 62% women; 17% minorities), 34% reported missing,,,1 dose of psychotropic medication within 10 days, 20% missed entire daily doses at least once, and only 2.5% missed all doses for 10 days. However, their prescribing psychiatrists considered only 6% as treatment-nonadherent. Factors significantly associated with nonadherence in multivariate modeling ranked: alcohol-dependence,>,youth,>,greater affective morbidity,>,various side effects,,,comorbid obsessive-compulsive disorder,,,recovering from mania-hypomania. Unrelated were sex, diagnostic subtype, and other comorbidities. Since most patients received,,,2 psychotropics, potential relationships between treatment-complexity and adherence were obscured. Conclusions Prevalent treatment-nonadherence among American BPD patients, and striking underestimation of the problem by prescribing clinicians may encourage increasingly complex treatment-regimens of untested value, but added expense, risk of adverse effects, and uncertain impact on treatment-adherence itself. Copyright © 2007 John Wiley & Sons, Ltd. [source] A Randomized, Double-Blind, Placebo-Controlled Pilot Study of Naltrexone in Outpatients With Bipolar Disorder and Alcohol DependenceALCOHOLISM, Issue 11 2009E. Sherwood Brown Background:, Alcohol dependence is extremely common in patients with bipolar disorder and is associated with unfavorable outcomes including treatment nonadherence, violence, increased hospitalization, and decreased quality of life. While naltrexone is a standard treatment for alcohol dependence, no controlled trials have examined its use in patients with co-morbid bipolar disorder and alcohol dependence. In this pilot study, the efficacy of naltrexone in reducing alcohol use and on mood symptoms was assessed in bipolar disorder and alcohol dependence. Methods:, Fifty adult outpatients with bipolar I or II disorders and current alcohol dependence with active alcohol use were randomized to 12 weeks of naltrexone (50 mg/d) add-on therapy or placebo. Both groups received manual-driven cognitive behavioral therapy designed for patients with bipolar disorder and substance-use disorders. Drinking days and heavy drinking days, alcohol craving, liver enzymes, and manic and depressed mood symptoms were assessed. Results:, The 2 groups were similar in baseline and demographic characteristics. Naltrexone showed trends (p < 0.10) toward a greater decrease in drinking days (binary outcome), alcohol craving, and some liver enzyme levels than placebo. Side effects were similar in the 2 groups. Response to naltrexone was significantly related to medication adherence. Conclusions:, Results suggest the potential value and acceptable tolerability of naltrexone for alcohol dependence in bipolar disorder patients. A larger trial is needed to establish efficacy. [source] Prevalence and cost of medication nonadherence in Parkinson's disease: Evidence from administrative claims data,MOVEMENT DISORDERS, Issue 4 2010Keith L. Davis MA Abstract We estimated the prevalence of medication nonadherence in Parkinson's disease (PD) and the association between treatment nonadherence and healthcare costs. Insurance claims from over 30 US health plans were analyzed. Inclusion criteria were as follows: PD diagnosis, ,1 PD-related prescription between 1/1/1997 and 12/31/2004, continuous health plan enrollment for ,6 months before and ,12 months after first PD prescription. Adherence, all-cause healthcare utilization, and all-cause costs were evaluated over 12 months post-treatment initiation. Adherence was measured using the medication possession ratio (MPR), with MPR < 0.8 defining nonadherence. Among patients identified for inclusion (N = 3,119), 58% were male and mean age was 69 years. Mean MPR was 0.58 and 61% of patients were nonadherent. Unadjusted mean medical costs were significantly higher (P < 0.01) among nonadherers ($15,826) compared with adherers ($9,228), although nonadherers had lower prescription drug costs ($2,684 vs. $3,854; P < 0.05). After controlling for confounders in multivariable analyses, a large positive relationship between nonadherence and both medical and total healthcare costs remained (+$3,451, P < 0.0001 and +$2,383, P = 0.0053, respectively). Medication adherence in PD is suboptimal and nonadherence may be associated with increased healthcare costs despite offsets from reduced drug intake. Efforts to promote medication adherence in PD may lead to cost savings for managed care systems. © 2010 Movement Disorder Society [source] Does fear of coercion keep people away from mental health treatment?BEHAVIORAL SCIENCES & THE LAW, Issue 4 2003Evidence from a survey of persons with schizophrenia, mental health professionals Mental health consumer advocates have long argued that involuntary treatment frightens persons with mental disorder and thus deters them from voluntarily seeking help. We surveyed 85 mental health professionals and 104 individuals with schizophrenia spectrum conditions to assess their experience with and perceptions of involuntary treatment and other treatment mandates. Of the clinicians, 78% reported that overall they thought legal pressures made their patients with schizophrenia more likely to stay in treatment. Regarding involuntary outpatient commitment, 81% of clinicians disagreed with the premise that mandated community treatment deters persons with schizophrenia from seeking voluntary treatment in the future. Of the consumer sample, 63% reported a lifetime history of involuntary hospitalization, while 36% reported fear of coerced treatment as a barrier to seeking help for a mental health problem,termed here "mandated treatment-related barriers to care." In bivariate analyses, reluctance to seek outpatient treatment associated with fear of coerced treatment (mandated treatment-related barriers to care) was significantly more likely in subjects with a lifetime history of involuntary hospitalization, criminal court mandates to seek treatment, and representative payeeship. However, experience with involuntary outpatient commitment was not associated with barriers to seeking treatment. Recent reminders or warnings about potential consequences of treatment nonadherence, recent hospitalization, and high levels of perceived coercion generally were also associated with mandated treatment-related barriers to care. In multivariable analyses, only involuntary hospitalization and recent warnings about treatment nonadherence were found to be significantly associated with these barriers. These results suggest that mandated treatment may serve as a barrier to treatment, but that ongoing informal pressures to adhere to treatment may also be important barriers to treatment. Copyright © 2003 John Wiley & Sons, Ltd. [source] | ||||||||||