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Family participation in treatment, post-discharge appointment and medication adherence at a Nigerian psychiatric hospital

  • Ademola B. Adeponle (a1), Brett D. Thombs (a2), Moruf L. Adelekan (a3) and Laurence J. Kirmayer (a4)

Summary

In low-income countries, clinicians must seek strategies to improve treatment adherence that are non-resource intensive and easily integrated into existing treatment structures. We conducted a prospective observational cohort study to investigate the relationship of family engagement in treatment during hospitalisation with post-discharge appointment and medication adherence in 81 patients from a Nigerian psychiatric hospital. After controlling for gender, diagnosis, mental state at discharge, and marital status, family involvement was significantly associated with appointment (P=0.047) but not medication adherence (P=0.590). Studies are needed to determine whether interventions based on engaging families in treatment can improve post-discharge adherence in this setting.

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Copyright

Corresponding author

Ademola B. Adeponle, Dision of Social and Transcultural Psychiatry, Department of Psychiatry, 1033 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada. Email: dradeponleab@yahoo.com

Footnotes

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Declaration of interest

None.

Footnotes

References

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1 Zygmunt, A, Olfson, M, Boyer, CA, Mechanic, D. Interventions to improve medication adherence in schizophrenia. Am J Psychiatry 2002; 159: 1653–64.
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5 Breen, A, Swartz, L, Joska, J, Flisher, AJ, Corrigall, J. Adherence to treatment in poorer countries. A New Research Direction? Psych Services 2007; 58: 567–8.
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Family participation in treatment, post-discharge appointment and medication adherence at a Nigerian psychiatric hospital

  • Ademola B. Adeponle (a1), Brett D. Thombs (a2), Moruf L. Adelekan (a3) and Laurence J. Kirmayer (a4)

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Family participation in treatment, post-discharge appointment and medication adherence at a Nigerian psychiatric hospital

  • Ademola B. Adeponle (a1), Brett D. Thombs (a2), Moruf L. Adelekan (a3) and Laurence J. Kirmayer (a4)
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eLetters

Re: Phenomenon of disappearing patient?

Ademola B. Adeponle, Physician
04 March 2009

Dr. Noushad was concerned that due to our "stringent inclusion criteria where patient's families must have visited once every 2 weeks" many otherwise eligible patients were excluded. Dr. Noushad indicated that"only 81 out of 387 patients met study criteria, and this could have significantly altered results."

Neither of these assertions is correct. As stated in the article (1),all patients "admitted between July and December 2004 and taking their medications as prescribed at discharge were eligible for the study." Family visitation frequency was used to determine extent of study involvement, not study eligibility.

Furthermore, the article states, "There were 81 patients who met study criteria and all consented to take part in the study." We do not know why Dr. Noushad believed that only 81 out of 387 patients met study criteria, although we did use the number 387 to describe an altogether different study in the introduction.

(1) Adeponle A, Thombs BD, Adelekan ML, Kirmayer LJ. Family participation in treatment, post-discharge appointment and medication adherence at a Nigerian psychiatric hospital. Br J Psychiatry. 2009;194:86-7.
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Conflict of interest: None Declared

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Phenomenon of disappearing patient?

Fabida Noushad
24 January 2009

The recent article by Adeponle et al highlights family participation in treatment and how this may affect adherence to follow up appointments and medication adherence. (1)

In the given study, only 81 out of 387 patients met study criteria, and this could have significantly altered results.

Could the reason for this be the stringent inclusion criteria where patient's families must have visited once every 2 weeks? For patients withlonger inpatient stay, families may have been unable to visit every 2 weeks for many months due to various commitments.

This is reflected also by the finding by authors that for 69.1% of patients, illness duration was more than or equal to a year.

Other involvements such as telephone contact; visits by close friendsmay have replaced the visits, and this could have been included in the inclusion criteria. Inclusion criteria should not be made too restrictive, as the study may lose representative ness and the ability to examine differences in the patient group, and may well suffer from the ‘disappearing patient’ phenomenon. (2 )

References

1 Family participation in treatment, post-discharge appointment and medication adherence at a Nigerian hospital. Ademola B. Adeponle, Brett D.Thombs, Moruf L.Adelekan and Laurence J Kirmayer.

2 Stephen M. Lawrie, Andrew M. McIntosh, Sanjay Rao. Critical Appraisal for Psychiatry,Elsevier Churchill Livingstone,2000
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Conflict of interest: None Declared

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The importance of appointment adherence in developing countries

S M Singh, Psychiatrist
24 January 2009

The study by Adeponle et al. (1) raises the important issue of familyinvolvement in the maintenance of appointment adherence and management of patients with mental illness. As has been pointed out by the authors, the family is an underutilized and unsung resource in developing countries andmay be a particularly important factor responsible for the reportedly better outcomes of patients with disorders such as schizophrenia. The issue of appointment adherence as opposed to treatment adherence is a neglected facet in psychiatric research and data are scarce. For instance,in a follow-up study of patients from North India who had been admitted with substance use disorders, appointment adherence significantly predicted better outcomes as opposed to other measures such as prophylactic agents or length of in-patient stay (2). Whereas similar datafrom developing countries are not available for non-substance-use related psychiatric disorders, it is possible that appointment adherence may be anindependent and important factor that predicts outcomes through a variety of pathways including treatment adherence, or better psychosocial support mechanisms. This is particularly so in developing countries such as India where doctors are generally looked up to as figures of authority.

1.Adeponle A, Thombs BD, Adelekan ML, Kirmayer LJ. Family participation in treatment, post-discharge appointment and medication adherence at a Nigerian psychiatric hospital. Br J Psychiatry. 2009;194:86-7.2.Singh S, Mattoo SK, Dutt A, Chakrabarti K, Nebhinani N, Kumar S, Basu D. Long-term outcome of in-patients with substance use disorders: A study from North India. Indian Journal of Psychiatry. 2008;50:269-73.
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