29P
The Relationship Between Medication Attitudes and Medication Adherence Among Medicaid Enrollees with Serious Mental Illness: Implications for Social Work
Social Workers play a critical role in supporting client engagement in health behaviors. For individuals with chronic medical conditions medication adherence has been identified as a leading opportunity for improving health outcomes by the World Health Organization. Medication adherence is particularly important for individuals with serious mental illness. The Theory of Planned Behavior suggests attitudes toward medications predict medication taking behavior. Previous research has found that fears and negative attitudes about psychotropic medications are associated with medication non-adherence. Antipsychotic medication adherence is associated with decreased risk for relapse and hospitalization, but at the same time is associated with increased health risks, including diabetes and dyslipidemias. In this study we compare the attitudes of individuals on antipsychotics to other psychotropic medications for 13 different medication concerns. In addition we compare the attitudes of adherent vs. non-adherent individuals on antipsychotic medications.
Methods:
MyPSYCKES is a web-based application developed by the New York State Office of Mental Health (NYS OMH) to strengthen consumers' ability to participate in clinical decision-making. Questions about consumers’ medication adherence behaviors and their concerns about medications were embedded into the tool (MyPSYCKES), which was implemented in twelve outpatient mental health clinics across New York State. Data was extracted for the first 832 consumers, including 459 individuals on antipsychotics and 373 individuals on psychotropics other than antipsychotics. We report the proportion of each group endorsing the 13 medication attitudes, the proportion with low medication adherence, and examine differences between groups using a Chi Square test.
Results:
Individuals on antipsychotic medications were similar to individuals on other psychotropic medications for most medication attitudes and beliefs examined. However, they were both more likely to report concerns about medication side-effects (35% vs. 27%, p=0.03), and less likely to report concerns that the medications were not helpful (43% vs. 49%, p=0.003). Few individuals on antipsychotics report non-adherence compared to those on other psychotropics (10% vs. 23%, p=<.0001). Individuals reporting non-adherence to antipsychotics were more likely to report concerns about side-effects than those who reported adherence to antipsychotic medications (49% vs. 33%, p=.03).
Conclusions and implications:
These findings suggest that individuals with serious mental illness on antipsychotic medications are similar to those on other psychotropic medications in their medication attitudes with some important differences. They are both more likely to see the value of the medication and to be more concerned about the side-effects of these medications. The concern about side-effects is amplified among those reporting non-adherence to their antipsychotic medication. Given the well-established cardiometabolic impacts of antipsychotic medications, these findings highlight the importance of decisional balance for individuals on antipsychotics. Social workers can help consumers identify and voice concerns about their health care, and to advocate for exploration of treatment options and shared decision-making with their prescriber. More research is needed to further explore these issues in behavioral health populations on antipsychotic medications.