Improving Medication Adherence in Patients With Schizophrenia

In this video, Amber Hoberg, NP, Centric Physicians Group, San Antonio, Texas, discusses an additional case study to complement her 2021 Psych Congress session, as well as key takeaways, medication non-adherence, and common misconceptions.

Hoberg and Jonathan M Meyer, MD, Clinical Professor of Psychiatry, University of California, San Diego, San Diego, California, presented a session titled "Solving Clinical Challenges in Schizophrenia" to a live and virtual audience at this weekend's conference.

Read the transcript:

Hi. My name is Amber Hoberg. I'm a psychiatric nurse practitioner. I own my own practice here in the San Antonio, Texas area. I service many different arenas. I do group homes. I take care of the chronically mentally ill in both the inpatient and outpatient settings. I'm super excited to be here today to share this information with you.

Just a quick clinical scenario or a case that I have is a 35 year old male that I see in my clinic, that has schizophrenia, actually a 20 year history of schizophrenia. One of the challenges that I've had with this patient is maintaining adherence to his medications.

He has tried multiple different typical, atypical antipsychotic medications. Adherence has been a big issue and for a multitude of reasons. One of the reasons is he doesn't like some of the side effects or adverse reactions that come with these medications.

Also, just remembering to take his medications on a daily basis is very difficult for him. He's got a lot going on in his personal life. Maintaining that adherence has been really difficult for him.

One of the things that I did with him to make sure he could maintain his adherence was we talked about a shared decision making model where we went through what he likes about taking the medications, what he doesn't like about taking the medications, and then narrowing it down to helping him identify where he thinks what treatment regimen would work best for him.

After discussing with him, giving him all the options, we made a decision together that he would be on a long-acting injectable medication. He started on that. I walked him through the process. I was with him every step of the way. I see him through a telehealth type scenario.

When he was getting his injections, I was there, talking him through. Then, again, every month that he gets his injections, I walk him through it and make sure that he's maintaining that adherence.

We've been six months now with him being on these long-acting injectables that he receives monthly. He's been doing wonderful. His schizophrenia is much better controlled. His voices, his delusional aspects have improved.

One of the biggest problems that he had with not taking his medications was being in the legal system. We have actually been able to keep him out of the legal system. He's been doing really, really well and living a very quality life at this point.

I would definitely talk with you guys about making sure that you do that shared decision-making process with your patients because it can be very helpful when maintaining that adherence.

A couple of things I want you guys to take away from today's session is how do we treat challenging patients with schizophrenia, how do we make sure that we maintain their adherence, and how do we increase their awareness so that they continue to stay on their medications and take their medications.

I hope that's something that we brought to you guys today about talking about maintaining that adherence, some of the treatment options that we have for some of these really challenging cases that we can get on a day-to-day basis. Any misconceptions I like to clear up about schizophrenia is definitely these patients can be very misunderstood. With the disease state itself comes poor judgment, poor insight into their disease.

Sometimes, it's making sure that they have this good understanding about why they need to stay on medications and that staying on medications actually improves their overall quality of life by decreasing their psychosis and improving their delusional aspects and also, when we come to some of the negative aspects that come with schizophrenia, improving those symptoms for our patients.

Working with your patients and understanding that non-adherence can be something that happens with these individuals. At every visit, making sure we're talking to them.

We're explaining to them about why adherence is important, understanding from the patient's perspective why they're being nonadherent.

Is it that they're really forgetting their medications, or is it something else? Maybe there are some adverse reactions that they don't like, or maybe it's the way that the medications are being prescribed, that they don't like the scheduling of these medications.

Working with our patients to identify why they are noncompliant and then working with them to try to improve their adherence. Shared decision making is something I use every day in my practice, where I sit down and I talk with the patients. We make out a list of positives and negatives regarding their medications and what would make them stay on this medication.

Maybe we need to consider or explore other options and what that would look like for my patient and then involving the patient to make sure they make that decision along with you. When they share in that decision making responsibility, they have some ownership in that. Therefore, adherence becomes a little more attainable with these patients.
Just some final thoughts. I hope you guys enjoyed this presentation today. I hope that all this, what Psych Congress has to offer in the agenda. I thank you guys for allowing me to be here today.

Amber Hoberg, FPMHNP-BC, is a Nurse Practitioner specialist in Boerne, Texas. She graduated in 2010, having over 12 years of diverse experience, especially as a nurse practitioner. She is affiliated with many hospitals including Nix Health Care System. Hoberg also cooperates with other doctors and physicians in medical groups including Centric Physicians Group Pllc.