Factors affecting Non-compliance to psychotropic drugs of patients
`with psychosis as perceived by their family members attending the
`psychiatric outpatient department at selected hospital, Mangalore
`
`Bharat Pareelr, llaman Kaila
`
`Abstract : Non-compliance or non-adherence to treatment is the degree to which a patient does not
`carry out the clinical recommendation of a treating physician or in other words ‘1 is taihre ofthe patient to
`follow the prescribed treatment reg'men. A descriptive. co-relational study carried out to idemify the factors
`affecting non-compiance to psychotropicdrugs as perceived by patients relatives visiting outpatient department
`of Father Millar Mertal Hospital Mangalore. A stmctured interview schedule was prepared and used for data
`collection from 100 subjects those fulfil the inclusion criteria (relatives of the psychotic patients who are
`visitirg to 0.20 with the patients & staying w'th the patient at least last six months) by using purposive
`sampling method aftergetting their consert. Finding revealed that various factors perceived as contributing to
`non cormliance. were disease characteristics related (62%). transportation problems (56%). poor comnunity
`mental health services (55%). drug side effects (52%). cultural myth (49%). socialtactors (48%). psychological
`8. motivational factors (47%),econon1'c factors (43%), knowledge 8. insight (31%). literacy (36%), & other
`factors such as misconception about treatment & difficuty in swallowing the tablets contribute to non-
`compliance (1 7%). Thus. the presentstudy concludedthatthere are many factors which contributing to non-
`convliance among patients with psychotic illness. Therefore. it is recommended that more emphasis trust be
`given on deinstitttionalization ofrnental health services and patients family education to reduce the burden on
`health care expenditure due to non-adherence
`
`.
`KGWONS _
`Non-compliance, psychotropic drugs,
`psychosrs. non-adherence
`
`Correspondance 3‘
`
`Bm We“
`_
`LecmmmW‘W
`Safawm’Vl’s’W’mWevKU’aM
`WWW-
`
`lnhoduction
`Non-compliance is a significant
`problem in all patient population. from
`children to elderly‘.
`It applies to nearly all
`chronic diseases and tend to worsen as longer
`a patient continues on drug therapy. Non-
`compliance is now a days is considered to be
`a major problem in health services of both
`developed and developing nations. Most of
`patients comply with treatment are between
`33% to 94%. with a median of 50% for long
`term therapy?
`
`Nmsinganduidwirerynesearm .iaumai, Vol-9, No.2,npmzo13
`
`56
`
`1
`
`Exhibi 2079
`Slaybadr v. Surritomo
`IPR202001053
`
`

`

`Compliance is important because it is
`directly related to the prognosis of the illness.
`Non-compliance is a serious problem and has
`many serious effects on overall treatment and
`prognosis of the illness.
`It is dangerous and
`costly, as in many illnesses noncompliance
`may signal that patient and physician goals
`and priorities differ regarding the treatment
`and its schedule. Non-compliance is a major
`problem with almost all psychotropic drugs.
`The patient who are non-compliant are more
`severely ill at the point of readmission to
`hospital, have more frequent readmission. are
`more likely to be admitted compulsorily and
`have longer in patient stay.?'5
`
`As per the statistics given in health
`inionnation of India that psychosis is the most
`common mental disorder among the patients
`treated in specialized mental hospital in Indiat.
`Psychosis is a major mental illness in which a
`person may distort reality or when people
`demonstrate gross impairment in reality
`testing. It is the problem, which affect both
`male and female but more in male. The
`
`prognosis in psychotic patient is not very
`good always and recurrence is very common
`due to non-compliance to medication 7
`
`Psychotropic drugs are now the first
`line treatment for almost every psychiatric
`illness with growing availability of wide range
`of drugs to treat mental illnessf. The patient
`on psychotropic drugs needs to take drug as
`prescribed and regular follow up is necessary
`to regulate long term therapy 9. Some patients
`do not follow the prescribed treatment
`because of various reasons. One of the major
`factors for re—hospitalization is found to be
`
`non-compliance in taking drugs. Non-
`compliance is a personal behavior thatdeviates
`from health related advice given by health care
`professional10 Poor medication compliance is
`found to be almost certainly the single most
`important factor in poor treatment response.
`The consequences of medication non-
`compliance are clinically equivalent to those
`of untreated or inadequately treated psychotic
`illness.9
`
`Non-compliance behavior depends on
`specific clinical situation such as nature of
`illness. treatment program etc.
`In general,
`about one third of all patients never comply
`with treatment. An overall figure assessed in
`number of studies indicates that 46% of
`
`patients do not have compliance with
`treatment at any given time"
`
`A study in USA found approximately
`50% of 2 billion prescriptions filled each year
`was not taken correctly and result in increased
`burden on health care expenditure. In India
`clear statistics are not available on non-
`
`compliance; however the situation is
`quantitatively similar across the globe.“. The
`problem of non-compliance as significant
`cause of morbidity and mortality12
`
`the problem
`Non-compliance is
`encountered by the all health professionals
`and it is not only the responsibility of nurses
`but also the responsibility of other health
`professionals to make the patient and relatives
`aware about the importance of being
`compliant to their medication, since non-
`compliance delays the patients restoration to
`full health.g
`
`Nursing and Midwilery Research Journal, Val-9, No.2, April 2013
`
`57
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`

`

`Psychiatric nurse spend the largest
`amount of time in direct patient contact &
`work with the long term management of
`psychiatric patients, the role of nurses become
`even more critical, particularly regarding
`psycho pharmacological treatment and the
`education of the patient and their families
`regarding compliance of these treatment
`agents‘9
`
`The investigator while working with
`psychiatric patients noticed that many patients
`with psychiatric illness get admitted with
`relapse. Keeping it in mind the present study
`conducted to identify the factors affecting Non-
`compliance to psychotropic drugs.
`
`Obiectives
`To identify the factors affecting non-
`compliance to psychotropic medication as
`perceived by the family members of patients
`with psychosis.
`
`Methodology
`This descriptive study was conducted
`on relatives of psychotic patients who were
`non-compliant to psychotropic medication at
`Father Muller Medical College & Hospital,
`Mangalore. Sample of 100 attendants who
`were visiting psychiatric outpatient
`department along with patients were selected
`using purposive sampling technique.
`Interview schedule was prepared that
`composed of two parts. Part 1 consisted of
`10 socio~demographic variables of psychotic
`patient; part-ll: contained 40 questions related
`to various factors affecting non-compliance.
`
`Eight experts of whom six from the field of
`psychiatric nursing and two from psychiatric
`medicine checked validity of the tool. Tool was
`translated into Kannada and Malayalam then
`again from Kannada and Malayalam to English
`and pre-tested on 10 subjects to check its
`clarity, feasibility, and practicality.
`It took
`around thirty minutes on an average to
`complete the interview schedule. The
`responded clearly and easily understood the
`language and no change made in final
`toolThe reliability of the tool was tested
`through split half method and reliability
`coefficient was found to be statically
`significant (p=0.78). The permission for data
`collection obtained from the concern authority,
`the investigator assured the anonymity to the
`subjects, and their consent obtained. The
`psychotic patients those were irregular on
`their follow up OPD visits were screened by
`evaluating their case files with the help of
`consultant psychiatrist and their relatives (who
`are visiting to 0.90 with the patients & staying
`with the patient at least last six months)
`wereinterviewed by using interview schedule.
`Data was analyzed using descriptive statistics.
`
`Results
`
`Tables 1 represent the data regarding
`socio demographic characteristics of
`psychotic patients. 29% of the patients were
`in the age group of 36 to 45 years followed
`by 45 or above years (28%) whereas 25%
`were under age group of 18-25 years and
`rest of the patients (1 8%) belonged to the age
`group of 26 to 35 years
`
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`Table 1: sociodemonraphic profile of psychotic patienls
`N =1 00
`
`Age (in years)
`18-25
`
`26-35
`36-45
`
`Above 45
`
`Gender
`Male
`
`Female
`
`
`
`Educational Status
`Cannot read & wn'te
`Can read & write
`
`Primary school (1-7)
`
`Secondary school (8-10)
`Pre-university (PUC)
`Graduate & above
`
`Total per month family income of
`Rs, 1000/- to 2000
`
`Rs. 2001/- to 3000
`
`Rs. 3001/- to 4000
`Rs. 4000/- and above
`
`Dilation of illness
`
`2 years
`
`3 years
`
`4 years
`
`More than 4 years
`
`Village
`
`Type of family
`Nuclear
`
`Jornt
`
`Furthermore, it was observed that more
`
`than half of the patients (60%) were male
`whereas 40% were female. One third of
`
`patients (32%) studied up to primary school,
`23% up to PUC, 19% up to secondary school,
`10% were illiterate whereas the equal numbers
`(10%) of patients were educated up to the
`graduation. Nearly half of the patients (46%)
`were having the total family income up to
`Rs.2000 per month, 22% were having income
`between Rs.2001 to 3000 per month, 13%
`between Rs.3001 to 4000 followed by 19%
`patients having family income above Rs. 4000
`per month. Most of patients (83%) were
`suffering from illness for more than 4 years,
`whereas few (13%) were suffering from
`illness with the duration of less than 4 years.
`Fourty percent patients were rural dwellers,
`32% were semi-urban (block level) dwellers
`and rest (26%)belonged to the urban area
`(district level & above). Two third of the
`patients (67%) were from nuclear family and
`rest (33%) lived in joint family.
`
`non-
`to
`Factors Contributing
`compliance as perceived by family members
`of psychotic patients:
`
`Most of the subjects (62%) perceived
`the following disease characteristics as a
`reason for non compliance of diesease such
`as chronic nature of illness, many number of
`tablets need to be taken in a day & require
`following long-term treatment regimen as
`highest contributing factor
`to non-
`compliance. Furthermore, transportation
`problem perceived as second most important
`(56%) reason for non-compliance. The third
`highest (55%) related factor revealed to
`
`Nursing and Midwilery Research Journal, Val-9, No.2, April 2013
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`

`

`noncompliance was poor community mental
`health services whereas almost similar
`
`number of subjects (52%) perceived drugs
`side effects as contributing to non-adherence
`to treatment.
`
`Almost half of the study participant
`perceived Cultural (49%), social (48%) and
`psychological (47%) factors as reason for
`non-compliance. Economic iactors (like
`shortage of money, cost of medicine etc...)
`perceived by 43% of study participant as
`contributing to non-complianceThe other
`factors related to non compliance were lack
`
`of knowledge, comprehensive and insight of
`illness as perceived by 31% whereas illiteracy
`perceived by 36% study participant as cause
`of non-compliance. Difficult in swallowing the
`Tablets revealed as contributing factor of non-
`compliance by 23% of patient's relatives
`whereas misconception about psychiatric
`procedures like ECT and other procedures
`perceived by 11% as reason for non-
`compliance. This revealed that there are many
`factors contributing to noncompliance to
`drugs among psychotic patient. (Fig. i)
`
`Fig. 1 Factors Affecting Non-Compliance to Psychotropic Drugs
`
`
`
`Discussion
`
`There is a need for mentally ill patients
`to take the medications regularly especially
`the patients who are on long-term therapy in
`order to prevent relapse of disease. However,
`it is observed that many patients do not
`comply with their treatment schedule.
`Administration of medication is a responsibility
`
`of the nurse or their relatives (at home)
`because the mentally ill patient (especially
`Psychotic Patient) lacks cognitive skill & insight
`to illness. They may not identity the need for
`medications. Very few systematic studies had
`been done on this issues especially on factor
`associated with non—compliant.
`
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`

`Present study observed that most of
`the patients were male and in age group of
`26-45 years. Maximum numbers of patients
`(83%) were chronically suffering from illness
`(more than 4 years) and most of them belong
`to rural area. Two-third of the patients were
`belongs to the nuclear family and were having
`monthly income in between Rs.1000-3000/-
`
`The present study explored various
`factors as contributing to non-compliance,
`majority of the subjects perceived disease
`characteristics related factors as main reason
`
`for non-complianceTransportation problems,
`poorcommunity mental health services, drug
`side effects, cultural myth, social factors,
`psychological & motivational factors.
`economic factors, lack of knowledge & insight
`of Illness.
`Illlteracy & other factors such as
`misconception about treatment & difficulty in
`swallowing the tablets were also revealed as
`contributing factors to non-compliance. These
`finding were consistence with finding of the
`study conducted by Taj. R Khan in Pakistan
`and reported commonest reason for non-
`compliance as lack of awareness of treatment
`benefits, non-affordability of drugs, physical
`side effects.Both the study reported almost
`similarfactor but different in magnitude based
`on amount of contributions to non-
`
`compliance”
`
`In present study stigma of illness,
`cultural myth,
`lack of knowledge about
`disease & treatment also reported as a
`contributing factor to non-compliance. These
`finding were consistent with the findings of
`Chan DW where the knowledge of treatment
`and side effects, perceived stigma of the
`
`illness. personal belief. were linked to the non-
`compliance“).
`
`The present study explored many
`factors, which were associated with non-
`
`compliance, the similar factors were observed
`in many studies across the world15‘ ‘9.
`In-
`consistency observed only among various
`factors in terms of their proportional
`contribution to non-compliance but the all
`reported factors consistently found as major
`cause of non-compliance all around the world
`therefore it is recommended that psychiatric
`patients & their family members must be
`motivated to treatment adherence & mass
`
`level awareness program on mental illness
`must be planned.
`
`Based on the finding of the present
`study it
`is recommended that a teaching
`program on importance of
`treatment
`compliance could be planned, conducted, and
`evaluated to find out the effectiveness not only
`for the psychiatric patients but also for all
`patients who are on long-term treatment. A
`similar study can be conducted by
`considering large geographical area to explore
`the variations in the factors contributing non—
`compliances
`
`The findings of the study have number
`of implications for nursing practiceThe
`nurses need to provide psycho-education to
`make patients and most importantly their
`relatives aware about the importance of
`regularly in treatment to prevent relapse.
`Nurses can also teach them about the their
`
`illness, side effects of the medication etc. The
`role here is educative and supportive to
`increase the self-care potentials of patients
`and their relatives.
`
`Nursing and MidwileryResearch Journal, Val-9, No.2, April 2013
`
`51
`
`

`

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