Elsevier

General Hospital Psychiatry

Volume 34, Issue 1, January–February 2012, Pages 72-79
General Hospital Psychiatry

Medication adherence and quality of life among Nigerian outpatients with schizophrenia

https://doi.org/10.1016/j.genhosppsych.2011.09.001Get rights and content

Abstract

Objective

The aim of this study was to examine medication adherence among outpatients with schizophrenia in relation to their subjective quality of life and other sociodemographic, clinical and service related factors.

Methods

Three hundred and thirteen consecutive outpatient clinic attendees with a Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) diagnosis of schizophrenia confirmed with the Structured Clinical Interview for Diagnosis were recruited for the study. Respondents were interviewed using a questionnaire evaluating sociodemographic, medication, illness and clinic attendance related variables. Medication adherence was assessed using the Morisky medication adherence questionnaire. Participants also completed the World Health Organization Quality of Life Scale-BREF questionnaire as a measure of their subjective quality of life, while severity of illness was measured using the Brief Psychiatric Rating Scale (BPRS).

Results

Overall, 40.3% of the respondents were medication nonadherent. Medication adherent respondents significantly reported their perceived social support as “good” (P=.006), took significantly fewer number of medications (P≤.001), had higher medication use recall scores (P≤.001), had lower total BPRS scores (P=.001) and were “very satisfied” with their outpatient care (P=.002). Independent predictors of medication nonadherence were BPRS score [odds ratio (OR)=1.08, 95% confidence interval (95% CI)=1.03–1.13], outpatient clinic default (OR= 4.97, 95% CI=2.59–9.53) and moderate satisfaction with outpatient care (OR=2.78, 95% CI=1.47–5.24). Medication nonadherence was significantly associated with lower scores on all domains and facets of quality of life.

Conclusions

Medication nonadherence is common among outpatients with schizophrenia and is associated with poor quality of life. Clinicians’ awareness of the risk factors for medication nonadherence early in patients’ management may significantly improve treatment outcomes, including patients’ quality of life.

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.

Section snippets

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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