Major mental health disorders are some of the most difficult conditions to manage. According to a retrospective analysis in Systematic Reviews, almost 450 million people are affected by mental health disorders worldwide, contributing 14% of the overall global burden of diseases, and 30% of the non-fatal diseases burden.
This is made worse by medication non-adherence. The paper’s authors, in reviewing 46 studies, found that adherence rates to psychotropic medications by condition were 56% for schizophrenia, 50% for major depressive disorders, and 44% for bipolar disorders.
Factors affecting mental health drug non-adherence
The Systematic Reviews authors found a number of factors associated with medication non-adherence:
In six studies, patients being busy with daily routines, careless about the timing of taking their medication, forgetting when to take their medication, and lacking regular follow-up were all associated with medication non-adherence.
Lack of information
The authors found another common factor in non-adherence: patients’ low level of understanding of their condition and their medication. Some patients believed they could get better without the medication, or said they felt better after terminating the medication.
Patients in seven studies reported that side effects such as dizziness, fatigue, tiredness, sedation, lethargy, and sleepiness kept them from taking their medication
Fear of stigma
In eight of the studies, patients’ feelings of being stigmatized by their families, health professionals, and community members made them more likely to be non-adherent.
Educational status and age
In six studies, mental health patients who had less than a secondary education were more likely to be non-adherent compared to those patients having a higher educational level. And patients over 60 and patients under 34 were also shown to be more likely to be non-adherent.
Three studies found a correlation with psychostimulants such as cigarettes, and six studies linked nonadherence to a dependency on alcohol.
Reducing mental health drug non-adherence
Payers, pharmacies, and pharmaceutical companies all have roles to play in addressing non-adherence to mental health medications. Because of the multiple factors associated with non-adherence, the Systematic Review authors recommended individually tailored, multifaceted approaches.
For pharmacists, the American Pharmacists Association suggests individual counseling by pharmacists to set up a solid therapeutic alliance. In counseling pharmacists should use open-ended questions to overcome patient skepticism about their medication; educate the patient about the benefits as well as side effects; and discuss the patient’s immediate and long-term needs. Pharmacists can address barriers to treatment by using once-a-day, long-acting medications to simplify the regimen; providing aids to improve adherence such as pill boxes or blister packs; and making use of pharmaceutical companies’ patient assistance programs.
Payers can reduce non-adherence by determining if they need to improve mental health treatment parity to increase access to treatment and support programs, so patients can get the medications they need. For patients on medications, payers may need to review their step therapy protocols. One study in The American Journal of Psychiatry about the use of step therapy in treating depression found that it had an unintended effect in reducing overall antidepressant use while increasing medical use and costs.
For pharmaceutical companies, improving adherence to mental health drugs is driven by innovation, whether developing longer-acting formulations or new treatments. Currently biopharmaceutical research companies have 138 medicines in development which promise help for millions of Americans living with mental illness.
How AI reduces non-adherence
For all of these groups, artificial intelligence can play a critical role in addressing non-adherence. For example, sophisticated AI technology can target patients who are likely to be both non-adherent and receptive to interventions. AI can then determine which interventions are most effective in supporting medication adherence.
AllazoHealth uses artificial intelligence to make a positive impact on individual patient behavior. We optimize medication adherence and quality outcomes for pharmaceutical companies, payers, and pharmacies. Building on our success in adherence, we have expanded our implementation of AI to include closing gaps in care and improving therapy initiation.