Predicting medication noncompliance among patients with schizophrenia after hospital discharge
Keywords:Noncompliance, Compliance, Schizophrenia, Medication, Acute Hospitalization, Drug attitude, Therapeutic alliance.
AbstractBackground: Medication noncompliance(NC) after hospital discharge is the main reason for poor outcomes of the clinical course of the schizophrenics subjects. In the present study we assess the patients with diagnosis of schizophrenia and predict the reason for medication noncompliance after hospital discharge on follow up period. Methods: A total of 70 patients (C=35, NC=35) with schizophrenia at 1month follow-up were interviewed using self-designed tools to assess sociodemographic data, insight, clinical symptoms, attitudes, therapeutic alliance, side-effects experienced and substance use disorder were assessed at baseline and 6month follow-up. Results: Mean age with ± SD in compliance(C) and noncompliance(NC) group is 32.45 ± 11.07 and 35.29 ± 13.45 respectively. Significant correlation between C and NC group in education level, SES (p = 0.011). Majority of patients in both groups are male (C=72.7%, NC=70.3%). NC is higher in illiterate, unmarried, joint family and Low SES. At 1month follow up, in NC group most patients are need of treatment (45.9%), reports of difficulty relabeling their symptoms (18.9%). Clinical symptoms in Mean ± SD, BPRS Score differ in C and NC group(p=0.052). At 6month follow up, 66 no’s of subjects came (C=35, NC=31). Significant reduction in the severity of the psychopathology BPRS score(P=0.000) and perceived side-effects (P=0.015). Improved quality of therapeutic relationship. Substance abuse, lack of awareness, attitudes and belief system, social isolation are reason for noncompliance. Discussion: As inpatient care, medication taking behavior is closely supervised by hospital staff, so compliance is high. Post-discharge follow-up is important for continued medication compliance in schizophrenic patients.NC increase the risk of relapse, rehospitalization, self-harm, lower quality of life. Conclusion: Public awareness concerning stigma to illness and antipsychotic medicine noncompliance should be further studied. With the current available pharmacological and psychological approaches that lowers risk of medication noncompliance should be encouraged in every patient, family members and medical personnel.
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