Patient Satisfaction Key to Psychiatry Adherence 'Crisis'

Liam Davenport

April 05, 2017

FLORENCE, Italy — High patient dropout rates and poor medication adherence in psychiatry could be turned around by focusing on factors that affect patient satisfaction and engagement with therapy, new research suggests.

A new meta-analysis identifies dozens of patient- and provider-related factors that affect patient satisfaction and engagement in psychiatry, many of which are related to patients' self-efficacy and knowledge and the quality of their relationship with their healthcare provider.

Study investigator Robin Gearing, PhD, associate professor, Graduate College of Social Work, University of Houston, Texas, told delegates attending the European Psychiatric Association (EPA) 2017 Congress here that "patients are more likely to overly report satisfaction in efforts to please their providers.

"Patients and providers overestimate adherence, specifically, the amount of medication that a patient is taking, and it's remarkable how little time is spent on adherence or satisfaction, according to the clients' perspective," he added.

The findings, he said, underline the influence of patient–provider communication and the quality of the therapeutic relationship in relation to adherence and satisfaction and point to ways in which the situation could be improved.

"The implications come down to this: Patients with greater provider satisfaction are more likely to pay for medications and attend treatment," said Dr Gearing.

Dr Gearing noted that effective and collaborative assessment do not guarantee engagement and that "a patient's motivation to remain committed and engaged with treatment, both medication and visits, may deteriorate and subsequently falter if [the patient is] not satisfied with their treatment or with you."

He pointed out that from 20% to 75% of patients who begin receiving psychosocial mental health services drop out or discontinue treatment and that 50% of patients with chronic illness do not take their medication as prescribed after 6 months.

For patients with bipolar disorder, the medication nonadherence rate is as high as 64%. For patients with depression, the rate can be as high as 60%. For patients with schizophrenia, the rate is 80%. "It's been called the Achilles heel of psychiatry and medicine," said Dr Gearing.

What Do Patients Want?

To determine what patients want from their relationship with their provider and how a provider can assess and evaluate patient satisfaction in relation to treatment engagement, Dr Gearing and colleagues searched the PsychINFO, Medline, and CINAHL databases for relevant articles published between 1996 and 2016.

They focused on peer-reviewed articles and placed an emphasis on meta-analyses, systematic reviews, and literature reviews. Of 1582 identified articles, they selected 49 for the final review. Of these, 29 studies addressed engagement or adherence, and 20 assessed patient satisfaction.

The analysis revealed three distinct domains for factors related to engagement and satisfaction: patient related; provider related; and patient–provider related. Each of these could be divided into several subdomains.

For example, with regard to patient-related factors that promote engagement, the team found 76 factors in 18 studies. These factors included patient self-efficacy, patients' knowledge of their condition, their health beliefs, and their quality of life.

Thirty provider-related factors that affected engagement were identified in 16 studies. These included not only the strategies that providers adopted to promote engagement, such as those related to patient motivation, style of approach, and level of contact, but also the type of provider and the provider's ethnicity.

Barriers to engagement were identified in 22 studies. These included 210 patient-related factors. Along with factors such as self-efficacy and health beliefs, the degree of family and social support was found to act as a barrier to engagement, as did economic factors, age, sex, and health status.

In the domain of provider-related factors, only two were identified that acted as barriers to engagement: provider experience and the type of provider.

Sixty-six patient–provider factors acted as barriers to engagement. These included the quality of the patient relationship, which was centered on trust and continuity of care, and the quality and degree of communication with the patient.

Patient factors that promoted patient satisfaction included economics, family support, patients' perceptions of health, and patients' self-efficacy. Provider factors that promoted patient satisfaction included competence, experience, ethics, and bedside manner and approach.

Barriers to patient satisfaction included the quality of the patient–provider relationship and continuity of care, as well as information sharing and the quality of information provided.

Alliance, Not Compliance

Commenting on the findings for Medscape Medical News, session chair Anita Riecher-Rössler, MD, PhD, Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Switzerland, said patient satisfaction and engagement are among "the most important" issues currently facing psychiatry.

"Our research is developing so well, and we know such a lot, but there is a huge gap in terms of how to transfer it to the clinic, to the patient, to have an alliance with the patient," she said.

"I definitely do not say 'compliance', I say 'alliance,' because it's not this old patriarchal thinking that the patient has to obey and to do you want. You must find ways to make an alliance with the patient, to communicate with the patient, to educate them about what you want, but also to listen...to his conceptualization of his mental disorder," she added.

More research needs to be undertaken to investigate how best to transfer research knowledge to patients in a user-friendly manner, said Dr Riecher-Rossler.

No funding for the study or relevant financial relationships have been disclosed.

European Psychiatric Association (EPA) 2017 Congress. Abstract O061, presented April 3, 2017.

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