Evidence Synthesis and Tables
Treatment Nonadherence Among Schizophrenia Patients-A Comprehensive Nursing Essay Example
Purposed statement
This paper aims to develop an evidence synthesis on motivational interviewing supported by technology as an evidence-based intervention for medication nonadherence.(Treatment Nonadherence Among Schizophrenia Patients-A Comprehensive Nursing Essay Example)
Practice Problem
The practice problem that this DNP project seeks to solve is treatment nonadherence among Schizophrenia patients. The majority of literature documents a high prevalence of nonadherence among patients diagnosed with Schizophrenia taking antipsychotic medication. A recent narrative review showed that Schizophrenia patients remain uninformed about medication, yet they value talks related to medications provided by healthcare professionals (Salzmann-Erikson & Sjödin, 2018). Remaining uninformed about medication is a significant barrier to treatment adherence, and practitioners are encouraged to adopt mechanisms to involve patients in their care.(Treatment Nonadherence Among Schizophrenia Patients-A Comprehensive Nursing Essay Example)
Evidence-Base Intervention (EBI)
The proposed intervention involves implementing technology with motivational interviewing (MI). Motivational interviewing will utilize OAR Model skills of open-ended questions, affirmations, reflective listening, and summary periods. MI is a long-standing EBI that primarily guides individuals to implement some changes (Mullen et al., 2020). MI utilizes the four principles of EDRS: expressing sympathy, developing discrepancy, rolling with client resistance, and supporting self-efficacy. In this regard, MI is considered direct and patient-centered counseling to help patients identify and resolve their ambivalent selves.(Treatment Nonadherence Among Schizophrenia Patients-A Comprehensive Nursing Essay Example)
National Context
Nonadherence is a serious problem that affects patients and the healthcare system globally and in the United States. Globally, the rate of nonadherence to Schizophrenia treatment is 50% (Viveiros et al., 2020). Conversely, between 26.5% and 58.8% of patients diagnosed with Schizophrenia report nonadherence (Salzmann-Erikson & Sjödin, 2018). Nonadherence to the associated psychotic relapse, worsening of the disease, mortality, increased suicide risk, hospital readmission, and increased healthcare costs. The cost of nonadherence for schizophrenia medication with reference to the impact on health, resources, and costs is estimated at $116434 (Cutler et al., 2018).(Treatment Nonadherence Among Schizophrenia Patients-A Comprehensive Nursing Essay Example)
Evidence Synthesis
Researchers have used motivational interviewing as an EBI for various clinical issues, including medication adherence. Zomahoun et al. (2017) evaluated the efficacy of MI on medication adherence among adults diagnosed with chronic illnesses. The study found that MI interventions successfully promote medication adherence in adults diagnosed with chronic diseases, including Schizophrenia. Harmaci & Budak (2022) assessed the effect of psychoeducation through motivational interviewing on medication adherence, psychological/psychosocial well-being, and a sense of hope among schizophrenia patients. The findings showed that using motivational interviewing techniques to provide psychoeducation effectively promotes medication adherence.(Treatment Nonadherence Among Schizophrenia Patients-A Comprehensive Nursing Essay Example)
Dobber et al. (2018) evaluated the interactions of MI among Schizophrenia patients. The study identified aspects of MI such as trusting relationships, integration of patients’ values, ability to adapt Motivational interviewing to patients’ situations, and their association with improved medication adherence among schizophrenia patients. Ertem & Duman (2019) assessed the effect of MI on insight levels and treatment adherence among schizophrenia patients. The findings showed improved medication adherence with MI. Chien et al. (2019) assessed the impact of adherence therapy through motivational interviewing among schizophrenia patients. The study findings revealed the cost-effectiveness of MI for medication adherence among schizophrenia patients, reduced rehospitalization, and positive psychosocial outcomes. The central theme highlighted across the studies is the positive role of MI on medication nonadherence. However, the different studies highlight the additional impact of MI on treatment-related factors such as patient insight, psychological/psychosocial well-being, and reduced rehospitalization.(Treatment Nonadherence Among Schizophrenia Patients-A Comprehensive Nursing Essay Example)
Conclusion
The practice problem that this DNP project seeks to solve is treatment nonadherence among Schizophrenia patients. Most of the literature documents a high prevalence of nonadherence to medication among Schizophrenia patients taking antipsychotic medication (Salzmann-Erikson & Sjödin, 2018). Existing literature supports the effectiveness of MI on medication adherence and associated benefits, including psychosocial well-being, reduced rehospitalization, and insight (Zomahoun et al., 2017; Harmaci & Budak, 2022; Ertem & Duman, 2019; Chien et al., 2019). Therefore, the present hypothesizes enhanced medication adherence among participants.(Treatment Nonadherence Among Schizophrenia Patients-A Comprehensive Nursing Essay Example)
References
Chien, W. T., Cheung, E. F., Mui, J. H., Gray, R., & Ip, G. (2019). Adherence therapy for Schizophrenia: A randomized controlled trial. Hong Kong Med J, 25(Suppl 2), 4-9. https://pubmed.ncbi.nlm.nih.gov/30674700/
Cutler, R. L., Fernandez-Llimos, F., Frommer, M., Benrimoj, C., & Garcia-Cardenas, V. (2018). Economic impact of medication nonadherence by disease groups: a systematic review. BMJ open, 8(1), e016982.(Treatment Nonadherence Among Schizophrenia Patients-A Comprehensive Nursing Essay Example) https://doi.org/10.1136%2Fbmjopen-2017-016982
Dobber, J., Latour, C., de Haan, L., Scholte op Reimer, W., Peters, R., Barkhof, E., & van Meijel, B. (2018). Medication adherence in patients with Schizophrenia: a qualitative study of the patient process in motivational interviewing. BMC Psychiatry, 18(1), 1-10(Treatment Nonadherence Among Schizophrenia Patients-A Comprehensive Nursing Essay Example). https://doi.org/10.1186/s12888-018-1724-9
Ertem, M. Y., & Duman, Z. Ç. (2019). The effect of motivational interviews on treatment adherence and insight levels of patients with Schizophrenia: A randomized controlled study. Perspectives in psychiatric care, 55(1), 75-86.(Treatment Nonadherence Among Schizophrenia Patients-A Comprehensive Nursing Essay Example) https://doi.org/10.1111/ppc.12301
Harmanci, P., & Budak, F. K. (2022). The Effect of Psychoeducation Based on Motivational Interview Techniques on Medication Adherence, Hope, and Psychological Well-Being in Schizophrenia Patients. Clinical Nursing Research, 31(2), 202-216. https://doi.org/10.1177/10547738211046438
Mullen, A., Isobel, S., Flanagan, K., Key, K., Dunbar, A., Bell, A., & Lewin, T. J. (2020). Motivational interviewing: Reconciling recovery-focused care and mental health nursing practice. Issues in Mental Health Nursing, 41(9), 807-814. https://doi.org/10.1080/01612840.2020.1731891
Salzmann-Erikson, M., & Sjödin, M. (2018). A narrative meta-synthesis of how people with schizophrenia experience facilitators and barriers in using antipsychotic medication: Implications for healthcare professionals. International Journal of Nursing Studies, 85, 7-18. https://doi.org/10.1016/j.ijnurstu.2018.05.003
Viveiros, C. P., Tatar, C. R., Dos Santos, D. V. D., Stefanello, S., & Nisihara, R. (2020). Evaluation of nonadherence to treatment among patients with Schizophrenia attending psychosocial care centers in the south region of Brazil. Trends in psychiatry and psychotherapy, 42, 223-229. https://doi.org/10.1590%2F2237-6089-2019-0072
Zomahoun, H. T. V., Guenette, L., Gregoire, J. P., Lauzier, S., Lawani, A. M., Ferdynus, C., … & Moisan, J. (2017). Effectiveness of motivational interviewing interventions on medication adherence in adults with chronic diseases: a systematic review and meta-analysis. International Journal of Epidemiology, 46(2), 589-602.(Treatment Nonadherence Among Schizophrenia Patients-A Comprehensive Nursing Essay Example) https://doi.org/10.1093/ije/dyw273.
Practice Question: For adults with a history of Schizophrenia in the inpatient setting, does implement technology with motivational interviewing (MI), compared with current practice, impact medication nonadherence in 8-10 weeks?(Treatment Nonadherence Among Schizophrenia Patients-A Comprehensive Nursing Essay Example)
Date:
Article Number | Author and Date | Evidence Type | Sample, Sample Size, Setting | Findings That Help Answer the EBP Question | Observable Measures | Limitations | Evidence Level, Quality |
46(2):589-602 | Zomahoun et al.
1 Apr 2017 |
Systematic review and meta-analysis of RCTs | 16 RCTs | MI enhanced medication adherence | · Medication adherence | · Limited effectiveness of MI | A/B High/Good Quality |
31(2): 202-216 | Harmaci & Budak
31 Feb 2022 |
RCT (Pretest-posttest control group design) | Schizophrenia patients
n=150
|
Enhanced medication adherence, hope, and psychological well-being levels. | · Medication adherence
· Hope · Psychological well-being |
· High drop-outs | Level I, High Quality |
18(1):135 | Dobber et al.18 May 2018 | Qualitative multiple case study based on RCTs | Schizophrenia patients
N=55
|
Enhanced medication adherence | · Medication adherence | · MI therapists are not expert
· Limited sample size
|
Level I, High Quality |
55(1):75-86. | Ertem & Duman
Jan 2019 |
Randomized Controlled Trial | Schizophrenia patients
N=40 Dokuz Eylül University, outpatient clinic |
Enhanced medication adherence | · Medication adherence
· Medication insight |
· Poor internal consistency of Morisky’s Questions-Self-Report Measure of Adherence
· Limited sample |
Level I, High Quality |
2(1):4-9. | Chien et al.
Feb 2019 |
Randomized Controlled Trial | None adherent schizophrenia patients
n=67 community psychiatric nursing services centers; New Territories West and Kowloon West |
Adherence therapy based on MI improved poor medication adherence among schizophrenia patients. | · Insight and Treatment Attitudes
· Medication adherence · Level of functioning · Re-hospitalization · Positive and negative symptoms |
Small and selective sample
Participants were nonblinded Impact of cofounding factors on medication not controlled |
Level I, High Quality |