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Improving Treatment Adherence in Your Patients with Schizophrenia

The STAY Initiative

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Abstract

Partial and non-adherence to medication is a common problem in schizophrenia, leading to an increased risk of relapse, increased likelihood of hospitalization and poorer long-term outcomes. In contrast, continuous medication in the treatment of schizophrenia is associated with positive outcomes, including improved clinical status, improved quality of life and functioning, and reduced risk of relapse and rehospitalization. Strategies aimed at improving medication adherence are therefore key for patients to achieve their treatment goals. In an attempt to address the issues of partial/non-adherence to antipsychotic medication in schizophrenia, a group of psychiatrists convened to discuss and develop a set of principles aimed at helping patients adhere to their medication. These principles were then refined and developed into the STAY (the Six principles to improve Treatment Adherence in Your patients) initiative following presentation to a wider group of psychiatrists from across Europe. This manuscript summarizes these principles and explains the rationale for their selection. These principles are: (1) recognizing that most patients with schizophrenia are at risk of partial/non-adherence at some time during the course of their illness; (2) the benefits of a good therapeutic alliance for identifying potential adherence issues; (3) tailored treatment plans to meet an individual’s needs, including the most suitable route of delivery of antipsychotic medication; (4) involving family/key persons in care and psychoeducation of the patient, assuming the patient agrees to this; (5) ensuring optimal effectiveness of care; and (6) ensuring continuity in the care of patients with schizophrenia. The application of these six principles should help to raise awareness of and address poor patient adherence, as well as generally improving care of patients with schizophrenia. In turn, this should lead to improved overall clinical outcomes for patients receiving long-term treatment for schizophrenia.

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Acknowledgements

The STAY initiative, including the various clinician meetings at which it was developed, was supported by Janssen.

The authors were fully responsible for content and editorial decisions for this manuscript. Editorial and writing support was provided by ApotheCom ScopeMedical Ltd, funded by Janssen.

The authors’ involvement in this initiative was part of consultancy work with Janssen. The authors would like to thank Professor Werner Kissling for the contribution he made to the discussions during the development of the initiative presented here.

FC has received honoraria for participating in advisory boards for Bristol-Myers Squibb, Janssen, Pfizer and Servier, and has received financial support/honoraria for his work as a speaker by AstraZeneca, Bristol-Myers Squibb, Janssen, MSD, Pfizer and Servier. He also received travel expenses from Janssen to attend the meetings where this content was developed.

KA has received grants and honoraria for consulting work from Lundbeck, Janssen, Pfizer, Schering-Plough, Bristol-Myers Squibb, Sanofi-Aventis, Sanovel, Zentiva and Eczacıbaşı, as well as consulting fees/honoraria from Wyeth, AstraZeneca and Santa Farma.

JMA has facilitated advisory boards for Janssen, Roche, Lilly, Lundbeck and Bristol-Myers Squibb, and has received financial support/honoraria from AstraZeneca, Lilly, Janssen, Lundbeck, Bristol-Myers Squibb, Servier and Roche. He also received fees for participating in data monitoring boards from Janssen, and travel expenses from Janssen to attend the meetings where this content was developed.

VD has received consulting fees/honoraria from Janssen and travel expenses from Janssen to attend the meetings where this content was developed.

RE has received consulting fees/honoraria and has participated in speaker/advisory boards for AstraZeneca, Bristol-Myers Squibb, Janssen, Lilly, Lundbeck, Organon, Pfizer, Servier, Otsuka and Wyeth. He has received research funding from Janssen, Lundbeck and AstraZeneca as well as travel expenses from Janssen to attend the meetings where this content was developed.

AGG has received consulting fees/honoraria from Janssen and has developed preclinical research projects with them.

PG has received consulting fees/honoraria from Bristol-Myers Squibb, Eli Lilly, Janssen, Lundbeck, Pfizer, Roche and Servier, has received payment for delivering lectures/participating in speaker bureaus by Bristol-Myers Squibb, Eli Lilly, Janssen, Lundbeck and Servier, and has received research grants from Eli Lilly and Servier. He also received travel expenses from Janssen to attend the meetings where this content was developed.

PMH has received honoraria for lecturing and consultancy work (including attending advisory boards) from AstraZeneca, Bristol Myers Squibb, Eli Lilly, Janssen, Lundbeck, Otsuka and Servier. He has received conference expenses from all these companies other than Lundbeck.

DN has received fees/honoraria from Janssen for lecturing and consulting work and received travel expenses from Janssen to attend the meetings where this content was developed.

JMO has participated in advisory boards for Eli Lilly, Janssen and AstraZeneca, has received consulting fees/honoraria from Janssen, Lundbeck, AstraZeneca, Eli Lilly, Bristol-Meyers Squibb, Sanofi-Aventis and Pfizer, and has received payment for lecturing from Eli Lilly, Janssen, AstraZeneca and Lundbeck. He also received travel expenses from Janssen to attend the meetings where this content was developed.

GP has received grants and consultancy fees/honoraria from Pfizer, Janssen, Schering-Plough, Bristol-Meyers Squibb, Servier and Novis, as well as grants from Lilly and travel expenses from Janssen to attend the meetings where this content was developed.

MR received consultancy fees/honoraria from Janssen and Servier and has received research grants for Janssen, Eli Lilly and Lundbeck. He also received travel expenses from Janssen to attend the meetings where this content was developed.

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Authors and Affiliations

  1. Hospital Dr Rodriguez Lafora, Department of Psychiatry, Cra. De Colmenar Viejo, 28049, Madrid, Spain

    Fernando Cañas

  2. Dokuz Eylül University School of Medicine, Izmir, Turkey

    Koksal Alptekin

  3. Sainte Marguerite Hospital, Marseilles, France

    Jean Michel Azorin

  4. Cliniques Universitaires St-Luc, Brussels, Belgium

    Vincent Dubois

  5. University of Stellenbosch, Tygerberg, South Africa

    Robin Emsley

  6. Autónoma University of Madrid, Madrid, Spain

    Antonio G. García

  7. Sainte-Anne Hospital (CMME), Paris V-Descartes University, Paris, France

    Philip Gorwood

  8. Cromwell House, Salford, and University of Manchester, Manchester, UK

    Peter M. Haddad

  9. Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany

    Dieter Naber

  10. Hospital Meixoeiro, Vigo, Spain

    José M. Olivares

  11. Evangelismos General Hospital, Athens, Greece

    Georgios Papageorgiou

  12. Hospital Juan March, Institut Universitari d’Investigaciò en Ciencies de la Salut, Palma de Mallorca, Spain

    Miquel Roca

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  1. Fernando Cañas
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  10. José M. Olivares
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Correspondence to Fernando Cañas.

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Cañas, F., Alptekin, K., Azorin, J.M. et al. Improving Treatment Adherence in Your Patients with Schizophrenia. Clinical Drug Investigation 33, 97–107 (2013). https://doi.org/10.1007/s40261-012-0047-8

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