title: Association between therapeutic alliance, care satisfaction, and pharmacological adherence in bipolar disorder.
abstract: OBJECTIVE
  We sought to understand the association of specific aspects of care satisfaction, such as patients' perceived relationship with their psychiatrist and access to their psychiatrist and staff, and therapeutic alliance with participants' likelihood to adhere to their medication regimens among patients with bipolar disorder.
  
  
  METHODS
  We examined data from the multicenter Systematic Treatment Enhancement Program for Bipolar Disorder, an effectiveness study investigating the course and treatment of bipolar disorder. We expected that participants (n = 3037) with positive perceptions of their relationship with their psychiatrist and quality of psychopharmacologic care, as assessed by the Helping Alliance Questionnaire and Care Satisfaction Questionnaire, would be associated with better medication adherence. We utilized logistic regression models controlling for already established factors associated with poor adherence.
  
  
  RESULTS
  Patients' perceptions of collaboration, empathy, and accessibility were significantly associated with adherence to treatment in individuals with bipolar disorder completing at least 1 assessment. Patients' perceptions of their psychiatrists' experience, as well as of their degree of discussing medication risks and benefits, were not associated with medication adherence.
  
  
  CONCLUSIONS
  Patients' perceived therapeutic alliance and treatment environment impact their adherence to pharmacotherapy recommendations. This study may enable psychopharmacologists' practices to be structured to maximize features associated with greater medication adherence.
authors.affiliation: Bipolar Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. lsylvia2@partners.org
authors.forename: Louisa G
authors.initials: LG
authors.lastname: Sylvia
authors.forename: Aleena
authors.initials: A
authors.lastname: Hay
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ostacher
authors.forename: David J
authors.initials: DJ
authors.lastname: Miklowitz
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.forename: Gary S
authors.initials: GS
authors.lastname: Sachs
authors.forename: Thilo
authors.initials: T
authors.lastname: Deckersbach
authors.forename: Roy H
authors.initials: RH
authors.lastname: Perlis
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy*; D004645:Empathy; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011446:Prospective Studies; D011787:Quality of Health Care; D011795:Surveys and Questionnaires