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Clinical interventions for treatment non-adherence in psychosis: meta-analysis

Department of Medicine and Public Health, Section of Psychiatry, University of Verona, Italy

RICHARD GRAY, PhD

Health Services Research Department, Institute of Psychiatry, London, UK

MICHELE TANSELLA, MD

Department of Medicine and Public Health, Section of Psychiatry, University of Verona, Italy

Correspondence: Dr Corrado Barbui, Department of Medicine and Public Health, Section of Psychiatry, University of Verona, Ospedale Policlinico, 37134 Verona, Italy. Tel: +39 045 8074441; fax: +39 045 585871; e-mail: corrado.barbui{at}univr.it

Declaration of interest None.

Background Studies investigating the efficacy of clinical interventions for reducing treatment non-adherence have generated contrasting findings, and treatment non-adherence remains common in clinical practice.

Aims To systematically review whether there are effective clinical interventions that community psychiatric services can implement to reduce non-adherence.

Method Systematic review and meta-regression analysis of randomised controlled trials (RCTs) and controlled clinical trials (CCTs) were used to assess the efficacy of interventions to enhance adherence.

Results We reviewed 24 studies, more than half of which were RCTs. In 14 studies the experimental intervention was an educational programme. Five studies evaluated pre-discharge educational sessions, three studies explored the benefit of psychotherapeutic interventions and two studies looked at the effect of telephone prompts. The overall estimate of the efficacy of these interventions produced an odds ratio of 2.59 (95% CI 2.21–3.03) for dichotomous outcomes, and a standardised mean difference of 0.36 (95% CI 0.06–0.66) for continuous outcomes.

Conclusions Community psychiatric services can potentially use effective clinical interventions, backed by scientific evidence, for reducing patient non-adherence.

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