Factors influencing adherence to psychopharmacological medication - the doctors' perspective

BACKGROUND: Adherence, in contrast to the formerly used term compliance, emphasizes the shared responsibility of physician and patient for treatment success or failure. Non-adherence is a pervasive problem in the treatment of chronic relapsing disorders. Factors that facilitate non-adherence are multifaceted and there is no standard evaluation method. Therefore, a trusting therapeutic relationship is of particular importance when it comes to establishing and fostering adherence, the diagnosis of the reasons for non-adherence and the development of improvement strategies. This work aimed to show which factors physicians who treat patients with psychiatric disorders blame for non-adherent behavior and which improvement strategies they consider appropriate. Based on the results, discrepancies to proven relevant influencing factors and possibly existing differences between the surveyed groups were analyzed.

METHOD: To achieve these objectives, a non-interventional, quantitative study design was adopted. Data collection was conducted once by questionnaire primarily in the form of a structured telephone interview with the alternative of completing the questionnaire online. The initial sample consisted of 500 physicians from Austria, of whom 250 were general practitioners and 250 were psychiatrists.

RESULTS: A total of 123 respondents participated in the survey (24.6 %), 50 general practitioners (40.7 %) and 73 psychiatrists (59.3 %). No statistically significant differences were found between the responses of the participating general practitioners and psychiatrists. Out of a total of twenty factors, the respondents rated (1) skepticism towards conventional medical treatments and (2) lack of time for patient discussion as most significant for non-adherence and (3) patient motivation, (4) trust in physician and (5) good effect of medication as most favorable for adherence. Respondents favored all ten suggested intervention strategies, especially (6) regular patient-doctor consultation and (7) intensive and extensive information.

CONCLUSION: The views of general practitioners and specialists were mostly congruent. The results are largely consistent with previous findings on factors influencing adherence and interventions to improve adherence and underline the significance of a trusting therapeutic relationship.