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Managing Medication Adherence in the Community

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Managing Medication Adherence in the Community
Challenges in managing medication adherence in the community
Assignment

Pierre Galea
MSc Mental Health Nursing
NUR 5116 Professional Issues In Mental Health Nursing

Introduction

In mental health, from the discovery of the drug Chlorpromazine in the 1950’s, which was a major breakthrough in the treatment of mental illness, medication played an important role in the move from the big psychiatric asylums to care in the community (Howland 2007).

Several studies continue to demonstrate the effectiveness of neuroleptic medication in the treatment of mental illness, and psychiatric nurses have an important role to play in the management of medication adherence (Gray et al 2004).

However, something we psychiatric nurses experience regularly in our practice, which is also referenced well in the literature, is the failure of patients with mental illness to adhere to their prescribed medication (Valenstein et al 2004, Razali 2010). Gray et al (2002b) argues that despite the effectiveness of new and modern antipsychotics, poor adherence to treatment remains common in people suffering from schizophrenia. This presents a big challenge for psychiatric nurses working in the community, especially since poor adherence to medication might cause deterioration in mental state, reduce quality of life and might lead to hospitalization. Poor adherence to medication might also imply an increase in the risk profile, which can be one of the main concerns for community psychiatric nurses, since they cannot rely on the hospital environment to safeguard and deal with the immediate consequences of non-adherence.

Moreover, apart from the suffering non-adherence bring to the patients and their families, poor adherence can have a global impact, since it can result in disruption of services, hospitalizations and increase bed use, lead to unemployment, and also presents a gap between the efficacy of (expensive) treatment and its delivery (Gray et al 2010). Gray et al (2002a)



References: Barker P. (2009) Psychiatric and Mental Health Nursing. (Second Edition) Edward Arnold Ltd Burns T Busby K.K. and Sajatovic M. (2010) Patient, Treatment and System-Level Factors in Bipolar Disorder Nonadherence: A summary of the literature. CNS Neuroscience and Therapeutics. 16: 308 – 315 Corrigan P.W Donoheo G. (2006) Adherence to Antipsychotic Treatment in Schizophrenia: What Role Does Cognitive Behavioral Therapy Play in Improving Outcomes? Disease Management and Health Outcomes 14 (4): 207-214 Finnell D.S Gordon W., Morton T.and Brooks G. (2005) Launching the Tidal Model: evaluating the evidence. Journal of Psychiatric & Mental Health Nursing 12 (6): 703-12 Gournay K Gray R., White J., Schulz M. and Abderhalden C. (2010) Enhancing medication adherence in people with schizophrenia: An international programme of research International Journal of Mental Health Nursing (19): 36-44 Gray R., Wykes T Homedes N. (1991) Do we know how to influence patient’ behaviour? Tips to improve patients’ adherence Family Practice 8 (4) :412-423 Horne R., Weinman J., Elliott R., Barber N Howland R.H. (2007) Medication Adherence Journal of Psychosocial Nursing 45 (9): 15-19 Jordan S., Hardy B Kemp R., Hayward P., Applewhaite G., Everitt B. And David A. (1996) Compliance therapy in psychotic patients: randomized controlled trial. British Medical Journal 312 (7027): 345-349 McCann T.V., Boardman G Muir-Cochrane E.C. (1998) The Role of the Community Mental Health Nurse in the administration of depot neuroleptic medication: Not Just the Needle Nurse! International Journal of Nursing Practice (4): 254-260 Razali S.M Walburn J., Gray R., Gournay K., Quraishi S. and David A.S. (2001) Systematic Review of patient and nurses attitudes to depot antipsychotic medication. British Journal of Psychiatry (179): 300-307 Ward F.M Weiss D.R. (2004) Adherence to pharmacotherapy in patients with alcohol and opiad dependence. Addiction, 99: 1382-1392

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