Effect of clinician-patient communication on compliance with flupentixol-melitracen in functional dyspepsia patients.
OBJECTIVE
To explore whether clinician-patient communication affects adherence to psychoactive drugs in functional dyspepsia (FD) patients with psychological symptoms.


METHODS
A total of 262 FD patients with psychological symptoms were randomly assigned to four groups. The patients in Groups 1-3 were given flupentixol-melitracen (FM) plus omeprazole treatment. Those in Group 1 received explanations of both the psychological and gastrointestinal (GI) mechanisms of the generation of FD symptoms and the effects of FM. In Group 2, only the psychological mechanisms were emphasized. The patients in Group 3 were not given an explanation for the prescription of FM. Those in Group 4 were given omeprazole alone. The primary endpoints of this study were compliance rate and compliance index to FM in Groups 1-3. Survival analyses were also conducted. The secondary end points were dyspepsia and psychological symptom improvement in Groups 1-4. The correlations between the compliance indices and the reductions in dyspepsia and psychological symptom scores were also evaluated in Groups 1-3.


RESULTS
After 8 wk of treatment, the compliance rates were 67.7% in Group 1, 42.4% in Group 2 and 47.7% in Group 3 (Group 1 vs Group 2, P = 0.006; Group 1 vs Group 3, P = 0.033). The compliance index (Group 1 vs Group 2, P = 0.002; Group 1 vs Group 3, P = 0.024) with the FM regimen was significantly higher in Group 1 than in Groups 2 and 3. The survival analysis revealed that the patients in Group 1 exhibited a significantly higher compliance rate than Groups 2 and 3 (Group 1 vs Group 2, P = 0.002; Group 1 vs Group 3, P = 0.018). The improvement in dyspepsia (Group 1 vs Group 2, P < 0.05; Group 1 vs Group 3, P < 0.05; Group 1 vs Group 4, P < 0.01) and psychological symptom scores (anxiety: Group 1 vs Group 2, P < 0.01; Group 1 vs Group 3, P < 0.05; Group 1 vs Group 4, P < 0.01; depression: Group 1 vs Group 2, P < 0.01; Group 1 vs Group 3, P < 0.01; Group 1 vs Group 4, P < 0.01) in Group 1 were greater than those in Groups 2-4. The compliance indices were positively correlated with the reduction in symptom scores in Groups 1-3.


CONCLUSIONS
Appropriate clinician-patient communication regarding the reasons for prescribing psychoactive drugs that emphasizes both the psychological and GI mechanisms might improve adherence to FM in patients with FD.
Xiu-Juan Yan, Wen-Ting Li, Xin Chen, Er-Man Wang, Qing Liu, Hong-Yi Qiu, Zhi-Jun Cao, Sheng-Liang Chen, Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai 200001, China.
Xiu-Juan
XJ
Yan
Xiu-Juan Yan, Wen-Ting Li, Xin Chen, Er-Man Wang, Qing Liu, Hong-Yi Qiu, Zhi-Jun Cao, Sheng-Liang Chen, Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai 200001, China.
Wen-Ting
WT
Li
Xiu-Juan Yan, Wen-Ting Li, Xin Chen, Er-Man Wang, Qing Liu, Hong-Yi Qiu, Zhi-Jun Cao, Sheng-Liang Chen, Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai 200001, China.
Xin
X
Chen
Xiu-Juan Yan, Wen-Ting Li, Xin Chen, Er-Man Wang, Qing Liu, Hong-Yi Qiu, Zhi-Jun Cao, Sheng-Liang Chen, Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai 200001, China.
Er-Man
EM
Wang
Xiu-Juan Yan, Wen-Ting Li, Xin Chen, Er-Man Wang, Qing Liu, Hong-Yi Qiu, Zhi-Jun Cao, Sheng-Liang Chen, Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai 200001, China.
Qing
Q
Liu
Xiu-Juan Yan, Wen-Ting Li, Xin Chen, Er-Man Wang, Qing Liu, Hong-Yi Qiu, Zhi-Jun Cao, Sheng-Liang Chen, Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai 200001, China.
Hong-Yi
HY
Qiu
Xiu-Juan Yan, Wen-Ting Li, Xin Chen, Er-Man Wang, Qing Liu, Hong-Yi Qiu, Zhi-Jun Cao, Sheng-Liang Chen, Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai 200001, China.
Zhi-Jun
ZJ
Cao
Xiu-Juan Yan, Wen-Ting Li, Xin Chen, Er-Man Wang, Qing Liu, Hong-Yi Qiu, Zhi-Jun Cao, Sheng-Liang Chen, Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai 200001, China.
Sheng-Liang
SL
Chen
D000328:Adult; D000368:Aged; D000873:Anthracenes / Q000009:adverse effects / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002681:China; D003142:Communication; D004338:Drug Combinations; D004415:Dyspepsia / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D005475:Flupenthixol / Q000009:adverse effects / Q000627:therapeutic use*; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D010817:Physician-Patient Relations; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D012074:Remission Induction; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D000873:Anthracenes; D004338:Drug Combinations; D005765:Gastrointestinal Agents; D054328:Proton Pump Inhibitors; D011619:Psychotropic Drugs; C000851:flupentixol, melitracen drug combination; D005475:Flupenthixol; D009853:Omeprazole
Anxiety; Compliance; Depression; Functional dyspepsia; Psychoactive drug