Medication adherence in schizophrenia: The role of family supervision, dosage frequency and medication knowledge

Abstract

BACKGROUND: Non adherence to antipsychotic medications in patients with schizophrenia leads to frequent relapses, poor treatment outcome, reduced quality of life and significant increases in healthcare cost in a resource poor country and a healthcare system already overburdened by infectious illnesses and other diseases. This study verified the adherence of people with schizophrenia and compared among adherent and non-adherent patients the impact of supervised treatment, regimen complexity and patients' understanding of medication regimen.
Objectives: The aim of this study was to assess the prevalence of poor treatment adherence to anti-psychotic medications and to explore its association with these potentially modifiable factors.
Method: This study is a cross sectional study of outpatients with schizophrenia in a tertiary healthcare facility in southeast Nigeria (n=150). The participants were aged 18 years and above, with illness duration of at least one year who have been on oral antipsychotic medications were selected using systematic sampling. They were assessed for socio-demographic details, dosage frequency, understanding of treatment regimen and availability of treatment supervision.
Results: The prevalence of treatment non-adherence was 52%. The factor most significantly associated with adherence was availability of treatment supervision (OR 0.055, 95%CI= 0.021-0.142 p-value <0.001). Other significant variables on univariate analysis include marital status (x2=5.035,df=1,p=0.03),  number of tablets taken per day (x2=10.667,df=1,p=0.01)  and patients' living arrangement (x2=4.287,df=1,p=0.03). The non-adherent patients were more likely to be living alone, less likely to be married, less likely to have supervised treatment and also less likely to be employed.   
Conclusion: Adherence to antipsychotic medications among patients with schizophrenia is suboptimal. Active intervention strategies should take these factors into consideration while implementing programmes to improve adherence behaviour among out-patients with schizophrenia.