(41) The Effectiveness of Non-pharmacological Intervention for Improving Medication Adherence of Dual-diagnosed Patients: A Literature Review

Mr. Chi-Kin IP¹, Prof Wai-Tong CHIEN^2
1Department of Psychiatry, North District Hospital, Hong Kong SAR, ²The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR

Background
Substance abuse is a global social and health challenge. With the increasing trend of abusing psychotropic substances, dual diagnosis (concomitance of substance-use and psychiatric disorder) has had significant impact on health care utilization (Choi, 2018; Schoeler et al., 2016). Pharmacotherapy is a gold standard of treatment for dual diagnosis in its acute and maintenance phase to improve mental condition and prevent relapse, respectively. However, poor medication adherence was often reported, leading to four-times higher in treatment refusal/withdrawal and doubled mortality rate (Clausen, Anchersen & Waal, 2007; Warden et al., 2012). Non-pharmacological interventions have been increasingly used but comprehensive review on their evidence for dual-diagnosed patients, especially effects on medication adherence, has not yet found; and thus this review was conducted.

Method
According to PICOS framework, a comprehensive search in 11 main electronic databases was done focusing on dual-diagnosed patients, non-pharmacological intervention, with control group, medication adherence (primary outcome), and RCT or quasi-experimental studies. Methodological appraisal of the identified studies was done by the Joanna Briggs Institute critical appraisal checklist.

Results
13 studies (7 RCTs and 6 quasi-experimental studies) were identified with acceptable methodological quality. Participants were mainly male (70.9%), mean age from 31.5 + 2.4 to 51 + 8.9 years old, and a wide variety of secondary psychiatric diagnoses and abused substances. Motivational interviewing (MI) could significantly improve medication adherence, psychiatric comorbidity and substance use, however, the results were still inconclusive due to limited small-sized, heterogeneous studies. Multimodal approach integrated MI into incentive management and/or case management may optimize its effects on medication adherence.

Discussion
Inconclusive preliminary effectiveness of MI-based intervention for improving medication adherence of dual-diagnosed patients are found. Further research is recommended to investigate the sustainable effects of MI and incentive management with case management approach, on enhancing intrinsic and extrinsic motivation, respectively, on medication adherence.

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