S-71-01

Does adherence therapy improve quality of life?

J. Bindman. Institute of Psychiatry, London, United Kingdom

Objective: Adherence with prescribed antipsychotic medication is of utmost importance for people suffering from schizophrenia in order to reduce symptoms and the risk of relapse, and thereby maintain good quality of life. However, rates of noncompliance are high (appr. 50%), and success of interventions to increase compliance has been limited so far. This study aims to establish the effectiveness and cost-effectiveness of Adherence Therapy, a pragmatic intervention aimed at increasing compliance to medication based on motivational interviewing, on improving quality of life.

Methods: The study is a randomised-controlled trial in four european sites (Amsterdam, Leipzig, London and Verona). Subjects with a diagnosis of schizophrenia and a history of clinical instability (admission or clinician rated relapse) who consent to take part are allocated to 8 sessions of therpay or 8 sessions of an educational control intervention. A baseline interview is conducted prior to treatment, and outcome assessed at one year follow-up using standard measures of quality of life, with the SF-36. as primary outcome.

Results: 409 subjects have been recruited, interviewed and treated and follow-up interviews have been completed.

Conclusion: Baseline characteristics of the sample will be discussed, a factor analysis of the SF-36. and its subscales will be presented and the suitability of the measure for the study and others of its type will be discussed.

S-71-02

Mediated relation of adherence to medication and quality of life in people suffering from schizophrenia

B. Puschner, A. Giegler, A. Born, H. Helm, T. Becker, The Quatro

Study Group. Ulm University, Department of Psychiatry 11, Guenzburg, Germany

Objective: A considerable bulk of research has been produced on adherence to medication and quality of life which are both considered important process-/outcome variables in the treatment of schizophrenia. However, the relation between adherence and quality of life in people suffering from schizophrenia has not been examined so far.

Methods: Since January 2002, a comprehensive longitudinal multi-center European study (participants in London, Verona, Amsterdam, and Leipzig) has been analysing effectiveness of Adherence Therapy, a pragmatic intervention based on motivational interviewing aimed at increasing adherence to medication. At each site, approx. 100 subjects have been randomly assigned to either eight sessions of Adherence Therapy or psychoeducation and are being followed up for one year.

Results: An extensive literature search on predictors of adherence to medication and quality of life in schizophrenia resulted in a detailed theoretical model specifiying the complex relationship between these two variables including a number of mediating factors. The theoretical model was then subjected to empirical verification via structural equation modelling which showed that there is hardly a direct effect of adherence on QoL, i.e. other variables such as symptomatic impairment, illness insight, depression, and global functioning, need to be included to obtain a meaningful model. Further analysis will focus on precise specification of the mediated path between adherence and quality of life and on the effect of the intervention. Conclusion: Implications of results for future research and practice will be discussed.

S-71-03

Developing adherence therapy

R. Gray. Institute of Psychiatry Denmark Hill, London, United Kingdom

Objective: To develop a pragmatic manualised intervention to enhance treatment adherence in people with schizophrenia Methods: Literature review Expert consensus opinion Pilot field-testing

Results: Adherence therapy is an eight-session intervention based on: compliance therapy; motivational interviewing; and cognitive behavioural therapy. There are four phases to the therapy: - Engagement - Assessment - Therapy - Evaluation During the therapy phase the therapist can select activities to do with the patient from a toolkit. Field testing suggested that the therapy was acceptable to patients with schizophrenia.

Conclusion: Adherence therapy is a brief psychological intervention to enhance adherence in people with schizophrenia.

S-71-04

The cost-effectiveness of adherence therapy for people with schizophrenia

A. Patel, P. McCrone, M. Knapp, K. Martijn, H. Helm, F.

Amaddeo, M. Leese, M. Moreno. Institute of Psychiatry Denmark Hill, London, United Kingdom

Objective: To present patterns of service use and costs associated with participants in the QUATRO study, a 4-country randomised controlled trial comparing adherence therapy with a health education programme for people with schizophrenia.

Methods: A comprehensive economic evaluation is being conducted as part of the QUATRO study. This has several main objectives: (1) to measure, describe and compare patterns of service utilisation within and across a number of cultural, sociodemographic and economic contexts, and across care systems and settings; (2) to calculate and compare direct and indirect costs of care; (3) to identify factors associated with service costs; (4) to compare alternative measures of quality of life; and (5) to assess the relative cost-effectiveness and cost-utility of adherence therapy in comparison with the control therapy. Economic data were collected by interview with participants, supplemented by health care records and information from key workers.

Results: Baseline data on patterns of service use and societal costs for a 3-month period will be presented. There are often challenges in the design and conduct of multi-country economic evaluations. We will describe the instrument used to collect comprehensive and comparable resource use data, the way in which unit costs of those resources were estimated across the 4 countries, and how the cost-effectiveness analyses will be undertaken.

Conclusion: Multi-country studies confer many advantages but also present challenges in the design and conduct of the economic evaluation. Further research is needed to assess the consequences of different design methods on the interpretation of findings.