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Clinical interventions for treatment non-adherence in psychosis: Meta-analysis

  • Michela Nosé (a1), Corrado Barbui (a2), Richard Gray (a1) and Michele Tansella (a1)
Abstract
Background

Studies investigating the efficacy of clinical interventions for reducing treatment non-adherence have generated contrasting findings, and treatment non-adherence remains common in clinical practice.

Aims

To systematically review whether there are effective clinical interventions that community psychiatric services can implement to reduce non-adherence.

Method

Systematic review and metaregression analysis of randomised controlled trials (RCTs) and controlled clinical trials (CCTs) were used to assess the efficacy of interventions to enhance adherence.

Results

We reviewed 24 studies, more than half of which were RCTs. In 14 studies the experimental intervention was an educational programme. Five studies evaluated pre-discharge educational sessions, three studies explored the benefit of psychotherapeutic interventions and two studies looked at the effect of telephone prompts. The overall estimate of the efficacy of these interventions produced an odds ratio of 2.59 (95% Cl 2.21–3.03) for dichotomous outcomes, and a standardised mean difference of 0.36 (95% Cl 0.06–0.66) for continuous outcomes.

Conclusions

Community psychiatric services can potentially use effective clinical interventions, backed by scientific evidence, for reducing patient non-adherence.

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Copyright
Corresponding author
Dr Corrado Barbui, Department of Medicine and Public Health, Section of Psychiatry, University of Verona, Ospedale Policlinico, 37134 Verona, Italy. Tel: +39 045 8074441; fax: +39 045 585871; e-mail: corrado.barbui@univr.it
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Declaration of interest

None.

Footnotes
References
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Clinical interventions for treatment non-adherence in psychosis: Meta-analysis

  • Michela Nosé (a1), Corrado Barbui (a2), Richard Gray (a1) and Michele Tansella (a1)
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eLetters

Long term benefit of reminder letters in reducing treatment non-adherence

C Feroz-Nainar, Acting Consultant in Learning Disability Psychiatry
08 April 2005

As the authors rightly point out there is a paucity of data with regard to the long term effectiveness of interventions to reduce treatmentnon-adherence.

We conducted a complete audit project at the learning disability clinics in South Birmingham to reduce the treatment non-adherence i.e. to reduce the missed appointments at the clinics (Feroz-Nainar et al, 2005). The sample size was 201. The non-adherence rate was high among the new referrals when compared to the follow-up appointments (61% vs 17%) and thedifference was highly significant. The intervention employed was sending reminder letters 3 days prior to the new appointments and this brought down the non-adherence rate significantly to 10%.

A 2-year follow-up study to measure the long term benefit of the intervention revealed that the non-adherence rate increased to 37% howeverthis was not statistically significant. This could have two possible explanations. As the sample size was small during the follow-up study the results may not have indicated a true reflection of the effectiveness of the intervention. Or it may mean that the intervention loses its effectiveness over time.

Another approach would be to target interventions at the factors found to be associated with treatment non-adherence for example substance abuse, unemployment etc. (Nose et al, 2003).

References

1.Feroz Nainar C, Meera Roy (2005) 'Non-attendance at learning disability out-patient clinics', e-letter published on the 8 Feb 2005 on the Psychiatric Bulletin website, http://pb.rcpsych.org/cgi/eletters/29/2/56

2.Nose et al, 'Clinical Interventions for treatment non-adherence in psychosis', British Journal of Psychiatry (2003); 183: 197-206.
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