Medication adherence and quality of life among Nigerian outpatients with schizophrenia
Introduction
Adherence to prescribed medications is an important determinant of quality of life especially in persons suffering from chronic illnesses such as schizophrenia [1]. Failure to adhere to prescribed antipsychotic medications in such patients has been associated with a higher risk of relapse, increased severity of relapses, increased mortality, rehospitalization and higher hospitalization costs [2], [3], [4], [5], [6]. A number of demographic and clinical variables associated with poor medication adherence have been reported in previous studies, some of which are negative attitude towards medications, previous nonadherence, poor insight, medication regimen complexity, poor therapeutic alliance, substance abuse and high scores on the Brief Psychiatric Rating Scale (BPRS) [1], [7], [8], [9], [10].
However, most of these studies were conducted in rich industrialized countries, and it is not known how generalizable their findings are to settings where health resources are scarce and unequally distributed, as seen in many developing countries. In Nigeria, for instance, mental healthcare services are largely hospital based, located in federal psychiatric hospitals, university teaching hospitals and few general hospitals. The poor accessibility of these services was highlighted by a recent study which found that only 9% of those diagnosed as having a mental illness in the previous 12 months had received treatment [11]. Outpatient clinics form the bulk of the service in most of these hospitals, and the clinics provide care on a fee-for-service basis. There is no government subsidy for medications, thus making the cost of treatment a burden largely borne by patients' family members [12]. These factors may militate against adherence to long-term therapies in persons with chronic illness such as schizophrenia. Furthermore, the relationship between subjective satisfaction with treatment and medication adherence in persons with schizophrenia, and the impact of poor medication adherence on their quality of life (QOL) have not been examined by previous studies in Nigeria. These factors need to be investigated for their treatment outcome to be improved.
The aim of this study therefore was to assess medication adherence among outpatients with schizophrenia in Nigeria and to examine its sociodemographic, illness-related and service-related correlates and its relationship with patients' QOL.
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Participants
The participants were adult patients attending the outpatient psychiatric clinic of the Neuropsychiatric Hospital, Aro, Abeokuta, Nigeria. The hospital has 526 bed units and renders services to patients from Nigeria and other West African countries. The hospital's outpatient clinics are run 4 days a week by consultant psychiatrists, supported by resident doctors, pharmacists and psychiatric nurses. Patients can obtain prescriptions for medication only by coming to the outpatient clinic. Between
Sociodemographic characteristics
The respondents comprised 163 males and 150 females, representing 52.1% and 47.9% of the sample, respectively. Their ages ranged from 18 to 64 years, with a median of 38.0 years. Most of the respondents (44.4%) were single, had completed only secondary school education (36.1%) and were employed (60.7%) at the time of the study. Majority of respondents received a monthly allowance/income in the US $33–$133 range, while more than two thirds (80.8%) of the respondents spent between US $13 and $33
Discussion
The aim of this study was to investigate the prevalence of medication nonadherence among outpatients with schizophrenia and to examine its relationship with patients' QOL.
The sociodemographic profile of this study group such as age, educational status, employment status and level of social support is comparable with earlier studies done in Nigeria among outpatient clinic attendees [19], [20]. The high cost of outpatient clinic attendance reported by many of the respondents may be largely
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