Katharine Gammon

October 23, 2013

Communication with a nurse between appointments improves patient adherence to psychiatric medication, a new study shows.

"The nurse–client relationship is really important. If a client feels you care about them, they're more likely to follow up with treatment," explained study author Valerie Markley, MSN, PMHCNS-BC, from Indiana University in Bloomington.

Markley created a study to look at interventions that could help adults with serious mental illness, such as major depressive disorder, bipolar, schizophrenia, and anxiety, to stick to their medications and show up at appointments.

She presented the results at the American Psychiatric Nurses Association 27th Annual Conference in San Antonio.

"It is well documented by the World Health Organization that about 50% of people with chronic illness from developed countries do not follow recommendations for treatment," Markley told Medscape Medical News. "It's even more important to understand adherence in psychiatric patients. I facilitate 2 groups and I see people who are doing well and then, all of a sudden, they don't come back."

The study involved 11 patients who received the intervention and 2 who did not.

If a client feels you care about them, they're more likely to follow up with treatment.

Patients were asked to keep a daily log of psychotropic medications taken as prescribed, and the goal of adherence was met when medication was taken 75% of time.

Markley explained that the communication was designed to focus on a brief review of medication taking, answer questions about adverse effects and therapeutic response, and convey empathy, caring, and support for the patient.

They found that the patients who communicated with the advanced practice registered nurse were more likely to adhere to prescribed medications than those who did not (< .001). They were also more likely to attend psychiatric appointments than those who did not have follow-up communication with a nurse.

Markley acknowledged that the study was small, and suggested that a follow-up study with more participants over a longer period of time be conducted.

Interventions like calls, texts, and emails may take time from a busy psychiatric practice, but hospitalizations and missed appointments come with a much greater price tag. For example, in England, missed appointments reportedly cost the healthcare system more than $980 million a year.

Stephen Magura, PhD, CSW, director of The Evaluation Center at Western Michigan University in Kalamazoo, who was not involved in the study, told Medscape Medical News that peer support for recovery is one of the factors that can help people follow medical instructions.

He explained that his research indicates that a multifaceted model improves adherence to medication.

The model includes brief interviewing at treatment entry to reinforce motivation for mental health treatment, discussion of possible medication adverse effects at every patient contact, and encouragement to participate in self-help groups that address both mental health and substance misuse issues," Dr. Magura told Medscape Medical News.

Ms. Markley and Dr. Magura have disclosed no relevant financial relationships.

American Psychiatric Nurses Association (APNA) 27th Annual Conference: Abstract 2013. Presented October 10, 2013.


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