Enhancing adherence for patients with Bipolar Disorder: A phase-I feasibility study

Aims and hypothesis

This phase-I feasibility study evaluated
an intervention embedding evidence-based psychoeducation with an advanced monitored dosage system in patients with bipolar disorder. The study aimed to:
•Understand healthcare professional and service user acceptability/satisfaction
•Evaluate medication adherence rating
•Evaluate the trend towards better adherence patterns

It was hypothesised that the intervention would enhance medication adherence and patient knowledge and understanding of bipolar disorder, with high user and healthcare professional (HCP) satisfaction.

Background

Treatment adherence is a frequent problem in bipolar disorder.

Partial or non-adherence can heavily influence patient outcomes, and is associated with exacerbation of symptoms, neurocognitive decline and increased risk of suicide.(1)(3)

Individually, both monitored dosage systems and psychoeducation have been identified as useful interventions in overcoming barriers to adherence.(4)(5) Few studies have examined the efficacy of monitored dosage systems combined with psychoeducation in patients with bipolar disorder.

Results

Biodose Connect® was reported to be helpful in reminding the patient to remain adherent, with one patient commenting that the Biodose Connect® tray reminded them to take their medication when they had forgotten. One patient reported enhanced independence due to being less reliant on others to maintain daily adherence.

Patients commented that the psychoeducation educated them on the value of coping strategies and on the importance of taking their medication in order to prevent relapse. Patients felt that the information given in the psychoeducation modules could additionally help loved ones to gain a greater understanding of bipolar disorder and signs of wellbeing.

HCPs felt Biodose Connect® allowed them to non-intrusively monitor medication adherence.

Methods

Four patients with bipolar disorder were provided with Biodose Connect®; a monitored dosage system holding a discrete GSM device allowing for medicine dosage tracking and permitting HCPs to intervene for those that had poor compliance. Patients were also assigned psychoeducation modules with video tutorials and e-Learning, encompassing subjects such as symptoms of bipolar disorder and episode triggers. Patients were instructed to use Biodose Connect® and psychoeducation throughout the two-month study duration.

A patient focus group was held at the end of the study period to gain feedback.

Conclusions

The main study limitation was patient recruitment which was affected by time restraints of the trial and restricted internet access required to complete the education modules.

Results from the focus group are favourable towards the benefit of the intervention in increasing medication adherence and patient and carer understanding of bipolar disorder. The findings support the study hypothesis that Biodose Connect®, coupled with evidence-based psychoeducation, could enhance medication adherence and patient knowledge and understanding of bipolar disorder, with high user and HCP satisfaction. Further research with a greater number of patients is warranted.

Funding

Funding for this study was provided by The Northern Ireland Small Business Research Initiative (SBRI) grant.