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HSR&D 2004 National Meeting Abstracts


2059. Qualitative Study of Antipsychotic Medication Adherence
Jeffrey M Pyne, MD, HSR&D Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, EP Fischer, HSR&D Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, R Spence, HSR&D Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, L Bragg, University of Arkansas for Medical Sciences

Objectives: Antipsychotic medication non-adherence is a major risk factor for poor outcomes and increased service use and remains a significant clinical challenge. To better understand this phenomenon we conducted qualitative interviews with patients diagnosed with schizophrenia or schizoaffective disorder to examine their perceived barriers, facilitators, and motivators (BFMs) for antipsychotic medication adherence.

Methods: Twenty-two patients (12 VA, 10 non-VA) completed in-depth interviews using a focused ethnographic approach. Their mental health providers completed a short answer hard-copy questionnaire referring to the patient, which was similar in format to the patient interview. Content analysis and constant comparison were used to analyze the patient data. The mean qualitative inter-rater agreement was 84.3%.

Results: From patient interviews we identified 174 barriers, 127 facilitators, and 176 motivators and these were organized into seven broad categories: environmental, side effects, clinical relationship/behavior, insight/knowledge, symptoms/outcomes, drugs and alcohol, and stigma. After eliminating duplicates, 87, 58, and 80 unique barriers, facilitators, and motivators, respectively, remained. The categories with the most frequent responses were environmental and symptoms/outcomes. The mean percent agreement between patient-identified BFM category and provider-identified BFM was 17% for barriers, 29% for facilitators, and 44% for motivators.

Conclusions: Patients were able to identify a wide variety of BFMs specific to antipsychotic medication adherence. There was poor percent agreement between patient- and provider-identified BFMs.

Impact: A substantial gap exists between patientsí and mental health providersí understanding about the factors that influence a patientís decision about taking antipsychotic medication. A user-friendly patient-centered adherence intervention may bridge this gap and improve antipsychotic medication adherence and treatment outcomes.