Psychiatrists' awareness of partial and nonadherence to antipsychotic medication in schizophrenia: results from an Asia-Pacific survey

Abstract

Background: Nonadherence is a well-known problem among schizophrenia patients, among whom relapse is fivefold more likely, adversely affecting health, employment, and social functioning. The Spanish Adherencia Terapéutica en la Esquizofrenia (ADHES) survey was developed to determine the scope and causes of medication nonadherence in schizophrenia.

Methods: The 20-question ADHES survey was distributed to 19,370 psychiatrists in 13 Asia-Pacific countries in January-April 2012, to ascertain psychiatrists' perceptions of antipsychotic medication adherence levels among their schizophrenia patients, reasons for partial/nonadherence, their preferred methods of assessing adherence, and strategies to improve adherence. Responses are reported as mean and range across countries.

Results: Four thousand, six hundred sixty one psychiatrists (24% of recipients) completed the survey (highest contributors: People's Republic of China, 1854; India, 1616). Psychiatrists perceived that 56% (range, 30%-71%) of schizophrenia patients were non- or partially adherent to medication. Patients discontinue medication primarily due to lack of insight into their condition (mean, 37%; 1%-65%) and because patients consider medication unnecessary when feeling better (mean, 27%; 15%-68%). Over half of psychiatrists (mean, 55%; 42%-99%) assess medication adherence at every visit, almost exclusively (81%) by asking their patients, versus quantitative measures. One in three psychiatrists expressed their preference to switch to or add a long-acting antipsychotic to improve adherence (15%-82%).

Conclusions: The substantial prevalence of partial/nonadherence to medication demonstrates that more proactive management of patients with schizophrenia is needed to improve adherence and thereby treatment outcomes.

Registration: Registration of this study was not required.

Keywords: APAC; adherence; antipsychotic; schizophrenia; survey.

Figure 1

Proportion of schizophrenia patients perceived to be partially or nonadherent to their antipsychotic medication.* Notes: *Of the patients with schizophrenia you saw in the past month, what percentage do you suspect may have been nonadherent, partially adherent, or fully adherent? Nonadherent was defined as <30% of prescribed doses taken; partially adherent was defined as ≥30%–<90% of prescribed doses taken; and adherent was defined as ≥90% of prescribed doses taken. Abbreviations: AU, Australia; CN, People’s Republic of China; HK, Hong Kong; IN, India; ID, Indonesia; KR, Korea; MY, Malaysia; NZ, New Zealand; PH, Philippines; SG, Singapore; TW, Taiwan; TH, Thailand; VN, Vietnam; APAC, Asia–Pacific.

Figure 2

Psychiatrists’ views on the most important reason for their schizophrenia patients discontinuing antipsychotic medication.* Notes: *What is, in your experience, the most important reason for your patients to discontinue medication? Responses do not always add to 100% as ‘no answers’ are not presented in the stacked bars. Abbreviations: AU, Australia; CN, People’s Republic of China; HK, Hong Kong; IN, India; ID, Indonesia; KR, Korea; MY, Malaysia; NZ, New Zealand; PH, Philippines; SG, Singapore; TW, Taiwan; TH, Thailand; VN, Vietnam; APAC, Asia–Pacific.

Figure 3

Psychiatrists’ views on the frequency with which they assess adherence in their patients.* Notes: *How often do you assess adherence in your patients? Responses do not always add to 100% as ‘no answers’ are not presented in the stacked bars. Abbreviations: AU, Australia; CN, People’s Republic of China; HK, Hong Kong; IN, India; ID, Indonesia; KR, Korea; MY, Malaysia; NZ, New Zealand; PH, Philippines; SG, Singapore; TW, Taiwan; TH, Thailand; VN, Vietnam; APAC, Asia–Pacific.

Figure 4

Psychiatrists’ views on the approaches they use to assess adherence.* Notes: *During your consultations, which approach do you normally use to assess adherence? Please select the approach you use most as well as all approaches you use. Responses do not add to 100% as multiple answers were allowed. Abbreviations: AU, Australia; CN, People’s Republic of China; HK, Hong Kong; IN, India; ID, Indonesia; KR, Korea; MY, Malaysia; NZ, New Zealand; PH, Philippines; SG, Singapore; TW, Taiwan; TH, Thailand; VN, Vietnam; APAC, Asia–Pacific.

Figure 5

APAC psychiatrists’ views on the preferred pharmacological approach they use to address an adherence problem in their patients.* Notes: *Please indicate which one of the following pharmacological strategies you would preferentially use to address an adherence problem in your patients with schizophrenia. Responses do not always add to 100% as ‘no answers’ are not presented in the stacked bars. Abbreviations: AU, Australia; CN, People’s Republic of China; HK, Hong Kong; IN, India; ID, Indonesia; KR, Korea; MY, Malaysia; NZ, New Zealand; PH, Philippines; SG, Singapore; TW, Taiwan; TH, Thailand; VN, Vietnam; APAC, Asia–Pacific.