King, Derek
(2010)
Non-adherence to medication in schizophrenia: the impact on service use and costs.
PhD thesis, London School of Economics and Political Science.
Abstract
Schizophrenia is a chronic illness which has severe consequences for the lives of patients and their families. The costs associated with treating individuals with schizophrenia are considerable. This thesis examined the relationship between non-adherence to medication, patient-, environmental- and medication-related factors and the costs associated with health and social care services used and the wider societal costs in treating individuals with schizophrenia. Analysis was undertaken of data from the 1993-4 and 2000 Psychiatric Morbidity Surveys and the Quality of Life following Adherence Therapy for People Disabled by Schizophrenia and their Carers study.
An individual’s level of education, having had a recent inpatient stay and alcohol abuse were found to be associated with a greater likelihood of non-adherence in individuals taking antipsychotics. These results were not observed in analyses of individuals taking antidepressants. Common factors associated with non-adherence across individuals taking antipsychotics and antidepressants included experiencing side-effects and severity of illness.
Community-based services were found to be used more by individuals with interruptions in their antipsychotic medication. In this group there may also be additional costs in hospitalisations and overall health and social care services attributable to non-adherence. Benefits to patients may be accrued by enabling health and social care professionals, particularly those working in the community, to encourage medication adherence in individuals with schizophrenia and to provide information on new interventions that are cost-effective in improving adherence.
National Institute of Clinical Excellence (NICE) guidelines for treating individuals with schizophrenia, revised in 2009, address some key findings in my analyses, such as emphasising the role of carers and family members in successful management of the illness, the potentially adverse impact that illicit drug use can have on therapeutic effects and issues around service provision to individuals from ethnic minorities.
Further analysis of data from long-term studies is required to determine the clinical, economic and personal consequences of non-adherence.
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