How often do patients with psychosis fail to adhere to treatment programmes? A systematic review.
BACKGROUND
Studies that assess the rates of psychotic patients who fail to adhere to treatment programmes have generated heterogeneous results, with estimates ranging from 24 to 90%. This paper presents findings from a systematic review on adherence to treatment by patients with psychosis. Its purpose is to provide an overall estimate of treatment non-adherence in community psychiatric services, and to analyse and study patient characteristics explaining the between-study heterogeneity in rates of non-adherence.


METHODS
A systematic review of published studies that report rates of non-adherence with medication and scheduled appointments by psychotic patients in community settings has been undertaken.


RESULTS
A total of 103 studies were included in this systematic review. Eighty-six of these studies were suitable for data re-analysis. The overall weighted mean rate of non-adherence, calculated in a sample of 23 796 patients, was 25.78%. A linear regression analysis of non-adherence rates on background characteristics showed that sample size was negatively associated with non-adherence rates, while first-contact cases and low-adherence cases, in comparison with ongoing cases, were associated with higher non-adherence rates. Factors associated with poor compliance included: lack of insight; positive symptoms; younger age; male gender; history of substance abuse; unemployment; and low social functioning.


CONCLUSIONS
Approximately one in four patients with psychosis fails to adhere with treatment programmes. Preventive evidence-based clinical interventions should be routinely implemented in community settings to reduce patient non-adherence.
Department of Medicine and Public Health, Section of Psychiatry, University of Verona, Verona, Italy.
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Nosé
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Barbui
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Tansella
D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D003156:Community Mental Health Services / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D006801:Humans; D011618:Psychotic Disorders / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D012044:Regression Analysis; D012307:Risk Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data*
D014150:Antipsychotic Agents