조현병환자의 복약이행도 개선전략

Review of Medication Adherence Improvement Strategies for Patients with Schizophrenia

BACKGROUND Medication nonadherence of the schizophrenic puts the patient in harm’s way and may bring the society to dangers. A summary of the existing literature on ways to improve the medication nonadherence would help protect the patient. OBJECTIVE This study aimed 1) to identify the list of reasons of medication nonadherence, 2) the list of strategies to alleviate medication nonadherence among the schizophrenic, and then 3) to assess how effectively each strategy addresses the specific reason of medication nonadherence. METHODS The reasons of medication nonadherence were identified from a most recent study of systematic review. For each identified reason, the strategies for improving the medication nonadherence were identified from a PubMed search of the studies published for the past 5 years. The effectiveness assessment of the strategies in addressing each reason was based on a 5 point-scale. RESULTS The number of reasons of medication non-adherence identified was 11, categorized into intentional vs. non-intentional ones. The number of strategies to improve the nonadherence was categorized into 6; pharmacist intervention, drug formulation, side effects, socio-cognitive behavioral modification, economic incentives and use of technology. While quite a few strategies aimed at addressing the problems of cognitive impairments, social support, and medication belief, few addressed the problems related to insight and social stigma. CONCLUSION This study found that strategies to improve the medication nonadherence work only when they target specific reasons. The study results inform healthcare providers of the importance of tailoring the medication nonadherence improvement strategy to each patient’s needs.