Role of Clinical Pharmacist in Promoting Patient Compliance through Assessment of Reasons for Non-Compliance and Minimum Maintenance Dose Titrations in Schizophrenic Patients
Authors: Mounica. Bollu, Shaik Faizan Ali, Dr. Desu Brahma Srinivasa Rao, Nallani Venkataramarao, Dr. Nalluri. Murali Krishna M.D
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Context: Medication non-compliance is an important area of concern in schizophrenia as it contributes to relapse and re-hospitalization of the patients. Constant advancement and study of therapeutic interventions designed to improve medication adherence and the outcome of dose titrations are required to reap the most valuable benefits from the pharmacologic treatment of schizophrenia. Aim & Objective: The aim of the present study is to find out the reasons for drug non-compliance and the effectiveness of treatment outcomes after dose titrations in schizophrenic patients and the main objective is to educate the patient by counseling about the disease, drugs and the importance of medication adherence. Materials and Methods: This study was conducted over a period of six months. All male and female subjects of age group 30-40 receiving anti-psychotic medications for a minimum of 1 year before the study starts and who were noncompliant to the prescribed medications were included. Results: Females were prominent in the non-adherent group and males were found to be higher in Group-B. Most of the schizophrenic patients were suffering with paranoid schizophrenia, living in the urban environment and running their nuclear families. Majority of the Subjects in the non-adherent group were illiterates and unemployed, where as in the dose titration group many have completed their primary education and were employed. Compared to first generation antipsychotics, second generation antipsychotic drugs were most commonly prescribed. Almost 56.07% do not have the support from their families. The main reasons stated by the patients to be noncompliant were difficulty in access to treatment, financial obstacles, forgetfulness. Dose titrations were made at an interval of 1 month for four antipsychotics (haloperidol, chlorpromazine, olanzapine and risperidone) and patients were benefited by the titration which was observed through the PANSS scores at each visit. Conclusion: Findings suggest that there is a need for identification and reduction of factors responsible for noncompliance. Strategies to improve adherence have the potential to reduce these costs. Dose titration shows beneficial effect to improve patient quality of life. Hence they should be implemented in clinical practice depending upon the individual patient.