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C-MAB: Collaborative Medication Adherence in Bipolar disorder

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What we did and why we did it

Around half of the people with mental illness do not take their medication as prescribed leading to relapse, hospitalisation and increased risk of suicide. This study aimed to understand what helps and hinders people from taking their medication as prescribed. We conducted focus group discussion and individual interviews with patients with bipolar disorder and their family and friends (n=33). We asked them about their views on what helped or hindered their medication taking. Their responses were transcribed and analysed to identify common themes.

Take away points

1. Mental health medication non-adherence is a significant clinical issue with huge economic impact.

2. Reasons for non-adherence are multifaceted, complex and unique to individual patients.

3. Clinicians should work together to explore those unique determinants and provide individualised adherence support.

What we found

We identified four key themes of medication adherence determinants:

1) The medications itself: efficacy and side effects of medication, pill burden, beliefs and knowledge about the medications, and emotion evoked by medications.

2) The practicalities - forgetfulness, access to prescriptions and medications, incompatible daily routine, practical support from friends and family to take medication or lack thereof.

3) How one sees themselves - not accepting the diagnosis or need for treatment, preference to alternative treatment, fear of stigma, worries of getting unwell and being sectioned.

4) Working with patients – being involved in treatment decision, being listened to, feeling supported by healthcare team and/or family and friends.

What’s Next?

Based on this research we have developed a questionnaire to identify non-adherence and individual determinants of non-adherence. We will be testing this questionnaire with around 500 people taking lithium for bipolar disorder. In the future, we plan to map each of the questions to evidence-based adherence intervention. So, based on patient’s response to the questionnaire, clinician can work with the patient to explore the best adherence support for individual patient.

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