Managing Medication Adherence in the Community

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Challenges in managing medication adherence in the community Assignment

Pierre Galea
MSc Mental Health Nursing
NUR 5116 Professional Issues In Mental Health Nursing


In mental health, from the discovery of the drug Chlorpromazine in the 1950’s, which was a major breakthrough in the treatment of mental illness, medication played an important role in the move from the big psychiatric asylums to care in the community (Howland 2007).

Several studies continue to demonstrate the effectiveness of neuroleptic medication in the treatment of mental illness, and psychiatric nurses have an important role to play in the management of medication adherence (Gray et al 2004).

However, something we psychiatric nurses experience regularly in our practice, which is also referenced well in the literature, is the failure of patients with mental illness to adhere to their prescribed medication (Valenstein et al 2004, Razali 2010). Gray et al (2002b) argues that despite the effectiveness of new and modern antipsychotics, poor adherence to treatment remains common in people suffering from schizophrenia. This presents a big challenge for psychiatric nurses working in the community, especially since poor adherence to medication might cause deterioration in mental state, reduce quality of life and might lead to hospitalization. Poor adherence to medication might also imply an increase in the risk profile, which can be one of the main concerns for community psychiatric nurses, since they cannot rely on the hospital environment to safeguard and deal with the immediate consequences of non-adherence.

Moreover, apart from the suffering non-adherence bring to the patients and their families, poor adherence can have a global impact, since it can result in disruption of services, hospitalizations and increase bed use, lead to unemployment, and also presents a gap between the efficacy of (expensive) treatment and its delivery (Gray et al 2010). Gray et al (2002a) argues that considering the improvement and advances in pharmacological interventions in psychiatry, the desired benefits of this medication is still not being reached due to the phenomenon of non-adherence. They insist that this presents a public health crisis, which continue to show the need for more studies and research in the area of medication adherence.


Throughout the literature, the word compliance and adherence is used intermittently. However, it seems that the word adherence is the most commonly used, also since it implies some degree of collaboration and involvement from the patient, unlike the word compliance, which describes the patient as a passive recipient who just obeys (or not) and follows the practitioner’s advice (Gray et al 2002a). Concordance seems to be the ideal way for the health practitioner to work with the patient, as it entails working in collaboration, involving the patient in decision making and respecting the patient’s opinions and decisions, even if the practitioner does not agree with them (Gray et al 2002a).

An interesting point raised by Horne et al (2005) is that total adherence or non-adherence is rare. It is not common that patients take their medication exactly the way it was prescribed. This is something which occurs commonly in the community, where the management of the medication is left almost solely to the patient, and sometimes their family. Patients take the control of the medication in their own hands (which is also something we encourage them to do) however this might result in missing, skipping, increasing or reducing the dose of the medication, against the prescriber’s advice.

Throughout this essay, the word adherence is going to be generally used, which portrays an amount of patient’s participation in the treatment plan.

Factors influencing medication adherence

Psychiatric nurses, need to look at the factors and understand why patients do not adhere to their treatment in order to manage...
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