Hamann Johannes, Lipp Marie-Luise, Christ-Zapp Sarah, Spellmann Ilja, Kissling Werner
Dr. Hamann, Ms. Lipp, Dr. Christ-Zapp, and Dr. Kissling are with the Psychiatry Department, Technische Universität München, Munich, Germany (e-mail:
Psychiatr Serv. 2014 Jul;65(7):881-7. doi: 10.1176/appi.ps.201300322.
Long-term results in schizophrenia treatment continue to be unsatisfactory, with many patients nonadherent to treatment and relapsing frequently. This study aimed to examine how perceived nonadherence leads psychiatrists to implement adherence-enhancing measures and to identify barriers and facilitators for the implementation of adherence-enhancing measures.
A cross-sectional survey was conducted with German hospital psychiatrists and their inpatients who had a diagnosis of schizophrenia or schizoaffective disorder.
Interviews were conducted with 121 psychiatrists or resident psychiatrists and their 213 inpatients. Psychiatrists recognized nonadherence as an important factor for hospital admission only when directly asked about it. Psychiatrists implemented a plethora of adherence interventions that in many cases constituted only intensive talks and no structured interventions. Of four core interventions addressed in the survey-depot administration of medication, psychoeducation for patients, psychoeducation for relatives, and arrangement of first follow-up visit-the implementation rates were surprisingly high for depot prescription of antipsychotics (>30%) and psychoeducation for patients but dramatically low for arrangement of follow-up visits and psychoeducation for relatives. Patients with poor previous adherence (according to the physician's estimate) received more adherence measures. In addition, patients with involuntary admission were more likely to receive depot medications, and psychoeducation was more often implemented for younger patients and for patients at university hospitals.
Treatment nonadherence is often underestimated by psychiatrists. Obstacles to the implementation of adherence-enhancing interventions occur in routine daily care. Integrated-care programs addressing adherence issues, communication between inpatient and outpatient treatment, implementation of adherence measures, and better involvement of patients in clinical decisions may help to overcome these barriers.
精神分裂症治疗的长期效果仍不尽人意，许多患者不坚持治疗且频繁复发。本研究旨在探讨感知到的不依从如何促使精神科医生采取增强依从性的措施，并确定实施增强依从性措施的障碍和促进因素。
对德国医院的精神科医生及其诊断为精神分裂症或分裂情感性障碍的住院患者进行了横断面调查。
对121名精神科医生或住院精神科医生及其213名住院患者进行了访谈。只有在直接询问时，精神科医生才将不依从视为住院的重要因素。精神科医生实施了大量的依从性干预措施，在许多情况下这些措施仅构成深入交谈，而没有结构化干预。在调查涉及的四项核心干预措施中——长效药物治疗、患者心理教育、家属心理教育以及安排首次随访——抗精神病药物长效处方（>30%）和患者心理教育的实施率出奇地高，但随访安排和家属心理教育的实施率极低。既往依从性差（根据医生估计）的患者接受了更多的依从性措施。此外，非自愿住院的患者更有可能接受长效药物治疗，年轻患者和大学医院的患者更常接受心理教育。
精神科医生往往低估治疗不依从的情况。在日常常规护理中存在实施增强依从性干预措施的障碍。解决依从性问题的综合护理计划、住院和门诊治疗之间的沟通、依从性措施的实施以及患者更好地参与临床决策可能有助于克服这些障碍。
